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The value of 18F-fluoride PET/CT in the assessment of screw loosening in patients after intervertebral fusion stabilization

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We evaluated 18F-fluoride PET/CT for the diagnosis of screw loosening after intervertebral fusion stabilization and compared the results with those from functional radiography.

Methods

A group of 59 patients with pain in the region of previous intervertebral fusion stabilization and suspicion of implant instability due to screw loosening were investigated with 18F-fluoride PET/CT and functional radiography, 30.1 ± 3.4 and 29.3 ± 3.2 months, respectively, after surgery. The criterion for loosening was increased focal uptake surrounding the screw entry point and shaft. SUVmax and SUVmean were measured in a region of interest (ROI) drawn around each screw (334 screws analysed). The final diagnosis was established by surgical exploration in 27 patients and clinical follow-up after intervertebral fusion stabilization in 32 patients.

Results

Of the 59 patients, 20 were proven positive for implant failure due to screw loosening and 39 were confirmed negative. The sensitivity, specificity and accuracy of 18F-fluoride PET/CT were 75 %, 97.4 % and 89.8 % in the patient-based analysis, and 45.6 %, 100 % and 80 % in the screw-based analysis, respectively. The positive and negative predictive values were 93.8 % and 100 % in the patient-based analysis, and 88.4 and 76 % in the screw-based analysis, respectively. CT signs in PET/CT allowed screw breakage to be detected in three patients. SUVmax, SUVmean and SUVmax/SUVmean ratios in screw ROIs and respective values in reference regions were all found to be significantly different between screws positive for loosening (58 screws) and screws negative for loosening (276 screws). The ratio between SUVmax in screw ROIs and the values in reference regions was the most significant parameter for distinguishing screws positive and screws negative for loosening.

Conclusion

18F-Fluoride PET/CT imaging is useful for the diagnosis of screw loosening in patients with persistent symptoms after intervertebral fusion stabilization.

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Conflicts of interest

None.

Authors’ contributions

C.P., T.S., L.R. and W.P. made substantial contributions to the conception and design of the study, and interpretation of data. T.S., J.H. and M.M.C. carried out the acquisition of data, and contributed to the analysis of data. C.P. and M.R. performed the analysis and interpretation of data, and were involved in drafting the manuscript.

Each author gave final approval of the version to be published.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Endocrinology, Paracelsus Medical University Salzburg, Müllner Hauptstrasse 48, A-5020, Salzburg, Austria

    Tanja Seifen, Margarida Rodrigues, Lukas Rettenbacher, Johannes Holzmannhofer & Christian Pirich

  2. Department of Neurosurgery, Paracelsus Medical University Salzburg, Ignaz-Harrer-Strasse 79, 5020, Salzburg, Austria

    Wolfgang Piotrowski

  3. Division of Neuroradiology, Paracelsus Medical University Salzburg, Ignaz-Harrer-Strasse 79, 5020, Salzburg, Austria

    Mark Mc Coy

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  1. Tanja Seifen
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  2. Margarida Rodrigues
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  3. Lukas Rettenbacher
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  4. Wolfgang Piotrowski
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  5. Johannes Holzmannhofer
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  6. Mark Mc Coy
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  7. Christian Pirich
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Correspondence to Christian Pirich.

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Seifen, T., Rodrigues, M., Rettenbacher, L. et al. The value of 18F-fluoride PET/CT in the assessment of screw loosening in patients after intervertebral fusion stabilization. Eur J Nucl Med Mol Imaging 42, 272–277 (2015). https://doi.org/10.1007/s00259-014-2904-6

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  • DOI: https://doi.org/10.1007/s00259-014-2904-6

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