Initial investigation of ¹⁸F-NaF PET/CT for identification of vertebral sites amenable to surgical revision after spinal fusion surgery.
OBJECTIVE
A pilot study was performed in patients with recurrent back pain after spinal fusion surgery to evaluate the ability of (18)F-NaF PET/CT imaging to correctly identify those requiring surgical intervention and to locate a site amenable to surgical intervention.


METHODS
In this prospective study 22 patients with recurrent back pain after spinal surgery and with equivocal findings on physical examination and CT were enrolled for evaluation with (18)F-NaF PET/CT. All PET/CT images were prospectively reviewed with the primary objective of identifying or ruling out the presence of lesions amenable to surgical intervention. The PET/CT results were then validated during surgical exploration or clinical follow-up of at least 15 months.


RESULTS
Abnormal (18)F-NaF foci were found in 16 of the 22 patients, and surgical intervention was recommended. These foci were located at various sites: screws, cages, rods, fixation hardware, and bone grafts. In 6 of the 22 patients no foci requiring surgical intervention were found. Validation of the results by surgery (15 patients) or on clinical follow-up (7 patients) showed that (18)F-NaF PET/CT correctly predicted the presence of an abnormality requiring surgical intervention in 15 of 16 patients and was falsely positive in 1 of 16.


CONCLUSIONS
In this initial investigation, (18)F-NaF PET/CT imaging showed potential utility for evaluation of recurrent symptoms after spinal fusion surgery by identifying those patients requiring surgical management.
Department of Radiology/Division of Nuclear Medicine, Stanford University Medical Center, Palo Alto, USA. aquon@stanford.edu
Andrew
A
Quon
Robert
R
Dodd
Andrei
A
Iagaru
Marcelo Rodrigues
MR
de Abreu
Sergio
S
Hennemann
Jose Maria
JM
Alves Neto
Clarice
C
Sprinz
D000328:Adult; D000368:Aged; D001416:Back Pain / Q000000981:diagnostic imaging; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012969:Sodium Fluoride; D013123:Spinal Fusion; D013131:Spine / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D012969:Sodium Fluoride