Sensitivity and specificity of thallium-201 scintigraphy for the diagnosis of malignant vertebral fractures.
OBJECTIVE
To evaluate the accuracy of thallium-201 (201TI) scintigraphy in distinguishing a benign from a malignant recent non-traumatic vertebral fracture.


METHODS
STUDY DESIGN--Single center, prospective study. PARTICIPANTS--Patients hospitalized for a recent non-traumatic vertebral fracture. EVALUATION--Usual clinical, laboratory and radiological assessment; 201TI vertebral scintigraphy: patients were injected with iv 3 mCi 201TI. Early and delayed images of the fractured vertebra were obtained. DATA ANALYSIS--(1) Two examinators, unaware of the other findings, rated the images as hyperfixation or not of the fractured vertebra; (2) the ratio (average count per pixel of the fractured vertebra/normal adjacent vertebrae) were calculated. The FINAL DIAGNOSIS was established on the result of vertebral biopsy or on follow-up.


RESULTS
Twenty-one patients were included. The final diagnosis was a benign vertebral fracture in 14 patients and a malignant vertebral fracture in 7. The sensitivity, specificity, positive and negative predictive values for a malignant fracture on early 201TI vertebral scintigraphy images were 28.6, 92.9, 66.6, and 72.2%, respectively, and on delayed images were 28.6, 100, 100, and 73.7%, respectively. The ratio of lesioned over normal tissue was not increased in malignant, compared with benign fractures.


CONCLUSIONS
The weak sensitivity does not support the wide use of 201TI bone scintigraphy to distinguish a benign from a malignant recent non traumatic vertebral fracture. However, the high specificity suggests that such evaluation might be proposed prior to vertebral biopsy in some difficult cases.
Department of Radiotherapy, CGF Leclerc, 1 rue Pr Marion, 21000 Dijon, France.
Juliette
J
Thariat
Michel
M
Toubeau
Paul
P
Ornetti
Bruno
B
Coudert
Alina
A
Berrielo-Riedinger
Pierre
P
Fargeot
Christian
C
Tavernier
François
F
Brunotte
Jean Francis
JF
Maillefert
D000368:Aged; D001706:Biopsy; D001859:Bone Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging; D013794:Thallium Radioisotopes; D013904:Thoracic Vertebrae / Q000293:injuries; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes