title: Rapid normalization of osseous FDG uptake following traumatic or surgical fractures.
abstract: It is known that following a traumatic fracture or surgical intervention, bone scintigraphy reveals positive results for an extended period of time, posing a challenge when evaluating patients for possible malignancy or superimposed osteomyelitis. Previous reports indicate that acute fractures can also result in increased fluorine-18 fluorodeoxyglucose (FDG) accumulation and therefore cause difficulties when patients are evaluated for other indications by FDG-PET. The purpose of this study was to assess the pattern and time course of abnormal FDG uptake following traumatic or surgical fracture. A total of 1,517 consecutive patients who underwent whole-body FDG-PET imaging were retrospectively studied. A history of fractures or orthopedic intervention was obtained from an interview prior to scanning. The FDG-PET results were compared with the results of other imaging studies, including bone scans, radiographs, CT, and MRI, as well as surgical pathology reports. Thirty-seven patients with a known date of traumatic or surgical fracture were identified. Among these, 14 had fractures or surgery within 3 months prior to FDG-PET, while 23 had fractures or surgical intervention greater than 3 months prior to FDG-PET. FDG-PET showed no abnormally increased uptake at the known fracture or surgical sites in 30 of these patients. Notably, in the 23 patients with fractures more than 3 months old, all but one showed no abnormally increased uptake. Furthermore, the positive FDG uptake in this exception was a result of complicating osteomyelitis. In the 14 patients with a history of fracture less than 3 months old, only six had abnormally increased FDG uptake. Following traumatic or surgical fractures, FDG uptake is expected to be normal within 3 months unless the process is complicated by infection or malignancy.
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Bldg, 3400 Spruce Street, Philadelphia, PA 19104, USA. zhuang@oasis.rad.upenn.edu
authors.forename: Hongming
authors.initials: H
authors.lastname: Zhuang
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Sam
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Chacko
authors.forename: Paulo S
authors.initials: PS
authors.lastname: Duarte
authors.forename: Marc
authors.initials: M
authors.lastname: Hickeson
authors.forename: Qi
authors.initials: Q
authors.lastname: Feng
authors.forename: Kozaim Z
authors.initials: KZ
authors.lastname: Nakhoda
authors.forename: Liang
authors.initials: L
authors.lastname: Guan
authors.forename: Phillip
authors.initials: P
authors.lastname: Reich
authors.forename: Shirley M
authors.initials: SM
authors.lastname: Altimari
authors.forename: Abass
authors.initials: A
authors.lastname: Alavi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000293:injuries / Q000378:metabolism / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000378:metabolism; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D014055:Tomography, Emission-Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18