title: Non traumatic vertebral lesions: incremental utility of PET-CT over MRI and FNAC in a suggested diagnostic algorithm.
abstract: OBJECTIVE
  To prospectively compare positron emission tomography-computed tomography (PET-CT) with conventional magnetic resonance imaging (MRI) and FNAC for diagnosis of non- traumatic vertebral lesions fracture in countries like India where tuberculosis is endemic.
  
  
  METHODS
  Fifty four patients with non-traumatic spontaneous vertebral lesions were prospectively studied. All patients underwent CEMRI focusing on the spinal lesions, whole-body PET-CT and FNAC.Results were then analysed and compared with final diagnosis obtained either by FNAC or clinical follow up.
  
  
  RESULTS
  Out of total 54 patients, FNAC from the spinal lesion could establish diagnosis in 36 patients (26 TB, 1 Fungal and 9 tumors). Of the remaining 18 patients, diagnosis could be established in 7 utilizing FNAC from other sites as dictated by PET-CT. In the remanining11 patients, the diagnosis and management was decided on the concordance of MRI and PET-CT.
  
  
  CONCLUSIONS
  All three investigations have their own advantages and pitfalls and they complement each other in reaching the final diagnosis. MRI has a better pick up rate (than PET-CT) for inflammatory lesions. PET-CT on the other hand has better sensitivity for malignant vertebral disease. Diagnosis was established if FNAC was conclusive. In cases where FNAC was inconclusive, an additional 38.9% patients' diagnosis could be established by FNAC from other sites of involvement as dictated by PET-CT. This was an incremental utility of PET-CT. When even this fails, there were two possible scenarios-MRI and PET-CT in concordance with each other. In such a scenario, the combined report of MRI and PET-CT was relied upon. The last sub group (where MRI and PET-CT were discordant and FNAC was inconclusive) still remains achilles' heel. Wide bore biopsy may help in establishing diagnosis in such group.
authors.affiliation: a Department of Neurosurgery, All India Institute Of Medical sciences , New Delhi , India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Meena
authors.affiliation: b Department of Neurosurgery, Post graduate institute of medical education and research , Chandigarh , India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: c Department of Nuclear Medicine, Post graduate institute of medical education and research , Chandigarh , India.
authors.forename: Anish
authors.initials: A
authors.lastname: Bhattacharya
authors.affiliation: d Department of Radiodiagnosis, Post graduate institute of medical education and research , Chandigarh , India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Gupta
authors.affiliation: e Department of Neurosurgery, Post graduate institute of medical education and research , Chandigarh , India.
authors.forename: Sivashanmugam
authors.initials: S
authors.lastname: Dhandapani
authors.affiliation: f Department of Neurosurgery, Post graduate institute of medical education and research , Chandigarh , India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chhabra
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000592:standards; D005260:Female; D006801:Humans; D007194:India; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis; D000072078:Positron Emission Tomography Computed Tomography / Q000592:standards; D011446:Prospective Studies; D013122:Spinal Diseases / Q000175:diagnosis*; D013125:Spinal Neoplasms / Q000175:diagnosis; D014399:Tuberculosis, Spinal / Q000175:diagnosis
keywords: FNAC; MRI; Non traumatic vertebral lesions; PET-CT