Use of FDG-PET in differentiating benign from malignant compression fractures.
OBJECTIVE
The objective was to evaluate the use of fluorodeoxyglucose positron emission tomography (FDG-PET) in differentiating benign from malignant compression fractures.


METHODS
In a retrospective analysis, we identified 33 patients with 43 compression fractures who underwent FDG-PET. On FDG-PET the uptake pattern was recorded qualitatively and semiquantitatively and fractures were categorized as benign or malignant. Standardized uptake values (SUV) were obtained. MRI, CT, and biopsy results as well as clinical follow-up for 1-3 years served as standards of reference. The Student's t test was used to determine whether there was a statistically significant difference between the SUV for benign and malignant compression fractures.


RESULTS
There were 14 malignant and 29 benign compression fractures, including 5 acute benign fractures. On FDG-PET, 5 benign fractures were falsely classified as malignant (false-positive). Three of these patients underwent prior treatment with bone marrow-stimulating agents. There were two false-negative results. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET in differentiating benign from malignant compression fractures were 86%, 83%, 84%, 71%, and 92% respectively. The difference between SUV values of benign and malignant fractures was statistically significant (1.9 +/- 0.97 for benign and 3.9 +/- 1.52 for malignant fractures, p < 0.001). SUV of benign acute and chronic fractures were not statistically significant.


CONCLUSIONS
Fluorodeoxyglucose positron emission tomography is useful in differentiating benign from malignant compression fractures. Therapy with bone marrow-stimulating agents can mimic malignant involvement.
Bredella
Miriam A
MA
Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA 02114, USA. mbredella@partners.org
Essary
Brendan
B
Torriani
Martin
M
Ouellette
Hugue A
HA
Palmer
William E
WE
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D050815:Fractures, Compression / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology; D013125:Spinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D013904:Thoracic Vertebrae / Q000293:injuries*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18