Journal Title
Title of Journal: Ann Nucl Med
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Abbravation: Annals of Nuclear Medicine
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Authors: Marloes J M Peters Roel Wierts Elisabeth M C Jutten Servé G E A Halders Paul C P H Willems Boudewijn Brans
Publish Date: 2015/08/05
Volume: 29, Issue: 9, Pages: 799-809
Abstract
A complication after spinal fusion surgery is pseudarthrosis but its radiological diagnosis is of limited value 18Ffluoride PET with its ability to assess bone metabolism activity could be of value The goal of this study was to assess the clinical feasibility of calculating the static standardized uptake value SUV from a short dynamic scan without the use of blood sampling thereby obtaining all dynamic and static parameters in a scan of only 30 min This approach was tested on a retrospective patient population with persisting pain after spinal fusion surgeryIn 16 patients SUVs SUVmax SUVmean and kinetic parameters K 1 k 2 k 3 v b K iNLR K 1/k 2 k 3/k 2 + k 3 K ipatlak were derived from static and dynamic PET/CT scans of operated and control regions of the spine after intravenous administration of 156–214 MBq 18Ffluoride Parameter differences between control and operated regions as well as between pseudarthrosis and fused segments were evaluated SUVmean at 30 and 60 min was calculated from kinetic parameters obtained from the dynamic data set SUVmean2TCM Agreement between measured and calculated SUVs was evaluated through Bland–Altman plotsOverall statistically significant differences between control and operated regions were observed for SUVmax SUVmean K iNLR K ipatlak K 1/k 2 and k 3/k 2 + k 3 Diagnostic CT showed pseudarthrosis in 6/16 patients while in 10/16 patients segments were fused Of all parameters only those regarding the incorporation of bone K iNLR K ipatlak k 3/k 2 + k 3 differed statistically significant in the intervertebral disc space between the pseudarthrosis and fused patients group The mean values of the patientspecific blood clearance rate tau differed statistically significant between the pseudarthrosis and the fusion group with a p value of 0011 This may correspond with the lack of statistical significance of the SUV values between pseudarthrosis and fused patients Bland–Altman plots show that calculated SUVmean2TCM values corresponded well with the measured SUVmean valuesLow back pain is a major global health and economic problem 1 2 3 with a 1year prevalence ranging from 22 to 65 and lifetime prevalence of up to 84 4 The direct costs including patient care medical procedures and medication are acceptable however the yearly indirect costs caused by absence from work and early retirement are manifold 2Low back pain is mainly caused by degenerative disorders of the spine such as spondylolisthesis degenerative scoliosis degenerative disc disease or recurrent disc herniations 5 6 If conservative measures such as intensive exercise therapy pain medication or brace immobilization fail spinal fusion is considered In at least 15 of primary lumbar fusions pseudarthrosis occurs instead of bony fusion 7 8 Pseudarthrosis is defined as the absence of solid fusion nonunion 1 year after the operation and is typically associated with axial or radicular pain 7 9 Although solid fusion is not required for pain relief 10 pseudarthrosis in general even without clinical symptoms increases the risk of clinical failure late deformity neurological symptoms and pain 11Surgical exploration remains the gold standard for diagnosing pseudarthrosis 7 9 12 13 14 15 Current noninvasive imaging assessment of pseudarthrosis in patients with persistent or recurrent symptoms after spinal fusion includes plain radiography flexion–extension radiography ultrasound bone scintigraphy computed tomography CT and magnetic resonance imaging MRI Most radiological modalities aim at the detection of wellestablished pseudarthrosis by looking at anatomical signs of bony connection between the vertebrae In contrast singlephoton emission computed tomography SPECT and positron emission tomography PET are 3D functional imaging modalities looking at biological processes underlying the process of fusion Therefore these imaging techniques may detect an evolving pseudarthrosis A few studies have reported on the use of PET/CT scanning for the detection of union/pseudarthrosis after spinal fusion and have indicated the value of 18Ffluoride PET/CT scanning in symptomatic patients 16 17 18 19
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