Differential Diagnostic Value of F-FDG PET/CT for Benign and Malignant Vertebral Compression Fractures: Comparison with Magnetic Resonance Imaging

Overview

Journal Cancer Manag Res

Publisher Dove Medical Press

Specialty Oncology

Date 2018 Jul 28

PMID 30050321

Citations 8

Authors

Xiaojiang He

Long Zhao

Xiuyu Guo

Liang Zhao

Jing Wu

Jingxiong Huang

Long Sun

Chengrong Xie

Haojun Chen

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study was to evaluate the differential diagnostic value of 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) for benign and malignant vertebral compression fractures (VCFs), where the diagnostic accuracy of F-FDG PET/CT was compared with magnetic resonance imaging (MRI).

Patients And Methods: Between 2015 and 2017, we retrospectively evaluated 87 patients with 116 VCFs. MRI was performed in all the 87 patients, whereas F-FDG PET/CT was executed in 51 patients. Three malignant features (convex posterior cortex, epidural mass formation, and pedicle enhancement) from MRI and the maximum standardized uptake value (SUV) from F-FDG PET/CT were evaluated in benign and malignant VCFs, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI and F-FDG PET/CT were compared in the differentiation of malignant from benign VCFs.

Results: The results of our investigation showed that the sensitivity and specificity for predicting malignant VCFs were 75.6% and 77.3% for convex posterior cortex, 82.9% and 813% for epidural mass formation, and 85.7% and 70.8% for pedicle enhancement. F-FDG PET/CT demonstrated higher sensitivity (100%) but lower specificity (38.9%) as compared to MRI with regard to differentiation between benign and malignant VCFs. A significant difference in the SUV values was observed between the benign and malignant fractures (2.9 ± 1.0 vs 5.0 ± 1.8, < 0.01). Besides the value of SUV, it has been noticed that the FDG uptake pattern differed in malignant and benign fractures.

Conclusion: Significant MRI findings such as convex posterior cortex, epidural mass formation, and pedicle enhancement are highly suggestive of malignancy. F-FDG PET/CT reliably differentiated the fractures of malignant from benign based on both SUV and F-FDG uptake pattern. In a situation where MRI findings are not diagnostic, F-FDG PET/CT provides additional information as it has high sensitivity and is semiquantitative.

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