The value of combined assessment of vertebral fractures with 99mTc MDP scintigraphy and MRI in selecting and planning percutaneous vertebroplasty.
BACKGROUND
Percutaneous vertebroplasty is a minimally invasive radiological procedure intended for relieving painful vertebral fractures. Suitability depends largely on fracture age, with acute osteoporotic fractures being most appropriate. Selection and planning usually involves either Tc MDP scintigraphy or MRI. There is evidence indicating that either modality is predictive of response to vertebroplasty, but there is limited evidence promoting their combined use.


OBJECTIVE
The aim of the study was to establish the degree of concordance between MRI and Tc MDP scintigraphy in vertebral fracture assessment.


METHODS
Our institution routinely uses both MRI and Tc MDP scintigraphy in vertebroplasty planning. This retrospective analysis included 39 patients, with a total of 73 vertebral fractures, all treated with vertebroplasty. The fractures were classified according to fracture age, aetiology and intermodality concordance.


RESULTS
The overall concordance between MRI and Tc MDP scintigraphy was 63%. Almost twice as many fractures classified as 'acute/ subacute' on MRI were so classified on Tc MDP scintigraphy.


CONCLUSIONS
Using MRI without Tc MDP scintigraphy, 48.2% of the potentially suitable vertebroplasty targets (37% of the total vertebral lesions) would likely have been overlooked. Clearly, Tc MDP scintigraphy and MRI provide different but complementary information on vertebral fractures, and these results support the use of dual-modality assessment in vertebroplasty selection and planning.
aDepartment of Radiology bDepartment of Nuclear Medicine cRadiological Sciences Unit, Imperial College Healthcare NHS Trust, London, UK.
Derfel
D
ap Dafydd
Shahenda
S
Salem
Imene
I
Zerizer
Wing
W
Yan Mok
Philip
P
Gishen
Maneesh C
MC
Patel
Neva H
NH
Patel
Adil
A
Al-Nahhas
Joel
J
Dunn
Zarni
Z
Win
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D013669:Technetium Tc 99m Medronate; D054854:Vertebroplasty
D013669:Technetium Tc 99m Medronate