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Rapid normalization of osseous FDG uptake following traumatic or surgical fractures

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

Abstract

It is known that following a traumatic fracture or surgical intervention, bone scintigraphy reveals positive results for an extended period of time, posing a challenge when evaluating patients for possible malignancy or superimposed osteomyelitis. Previous reports indicate that acute fractures can also result in increased fluorine-18 fluorodeoxyglucose (FDG) accumulation and therefore cause difficulties when patients are evaluated for other indications by FDG-PET. The purpose of this study was to assess the pattern and time course of abnormal FDG uptake following traumatic or surgical fracture. A total of 1,517 consecutive patients who underwent whole-body FDG-PET imaging were retrospectively studied. A history of fractures or orthopedic intervention was obtained from an interview prior to scanning. The FDG-PET results were compared with the results of other imaging studies, including bone scans, radiographs, CT, and MRI, as well as surgical pathology reports. Thirty-seven patients with a known date of traumatic or surgical fracture were identified. Among these, 14 had fractures or surgery within 3 months prior to FDG-PET, while 23 had fractures or surgical intervention greater than 3 months prior to FDG-PET. FDG-PET showed no abnormally increased uptake at the known fracture or surgical sites in 30 of these patients. Notably, in the 23 patients with fractures more than 3 months old, all but one showed no abnormally increased uptake. Furthermore, the positive FDG uptake in this exception was a result of complicating osteomyelitis. In the 14 patients with a history of fracture less than 3 months old, only six had abnormally increased FDG uptake. Following traumatic or surgical fractures, FDG uptake is expected to be normal within 3 months unless the process is complicated by infection or malignancy.

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References

  1. Matin P. Appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med 1979; 20:1227–1231.

    Google Scholar 

  2. Schulte M, Brecht-Krauss D, Heymer B, et al. Grading of tumors and tumorlike lesions of bone: evaluation by FDG PET. J Nucl Med 2000; 41:1695–1701.

    CAS  PubMed  Google Scholar 

  3. Aoki J, Watanabe H, Shinozaki T, et al. FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology 2001; 219:774–777.

    CAS  PubMed  Google Scholar 

  4. Carr R, Barrington SF, Madan B, et al. Detection of lymphoma in bone marrow by whole-body positron emission tomography. Blood 1998; 91:3340–3346.

    PubMed  Google Scholar 

  5. Guhlmann A, Brecht-Krauss D, Suger G, et al. Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis. J Nucl Med 1998; 39:2145–2152.

    CAS  PubMed  Google Scholar 

  6. Zhuang H, Duarte PS, Pourdehand M, Shnier D, Alavi A. Exclusion of chronic osteomyelitis with F-18 fluorodeoxyglucose positron emission tomographic imaging. Clin Nucl Med 2000; 25:281–284.

    CAS  PubMed  Google Scholar 

  7. Schmitz A, Risse HJ, Kalicke T, Grunwald F, Schmitt O. FDG-PET for diagnosis and follow-up of inflammatory processes: first results from an orthopedic view. Z Orthop Grenzg 2000; 138:407–412.

    Article  CAS  Google Scholar 

  8. Zhuang H, Duarte PS, Pourdehnad M, et al. The promising role of F-18-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med 2001; 42:44–48.

    CAS  PubMed  Google Scholar 

  9. Franzius C, Sciuk J, Daldrup-Link HE, Jurgens H and Schober O. FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med 2000; 27:1305–1311.

    CAS  PubMed  Google Scholar 

  10. Moog F, Kotzerke J, Reske SN. FDG PET can replace bone scintigraphy in primary staging of malignant lymphoma. J Nucl Med 1999; 40:1407.

    CAS  PubMed  Google Scholar 

  11. Meyer M, Gast T, Raja S, Hubner K. Increased F-18 FDG accumulation in an acute fracture. Clin Nucl Med 1994; 19:13–14.

    CAS  PubMed  Google Scholar 

  12. Karp JS, Muehllehner G, Qu H, Yan XH. Singles transmission in volume-imaging PET with a137Cs source. Phys Med Biol 1995; 40:929–944.

    CAS  PubMed  Google Scholar 

  13. Bedigian MP, Benard F, Smith RJ, Karp JS, Alavi A. Whole-body positron emission tomography for oncology imaging using singles transmission scanning with segmentation and ordered subsets expectation maximization (OS-EM) reconstruction. Eur J Nucl Med 1998; 25:659–661.

    CAS  PubMed  Google Scholar 

  14. Ma LD, Frassica FJ, Bluemke DA, Fishman EK. CT and MRI evaluation of musculoskeletal infection. Crit Rev Diagn Imaging 1997; 38:535–568.

    CAS  PubMed  Google Scholar 

  15. Seabold JE, Nepola JV. Imaging techniques for evaluation of postoperative orthopedic infections. Q J Nucl Med 1999; 43:21–28.

    CAS  PubMed  Google Scholar 

  16. Kalicke T, Schmitz A, Risse JH, et al. Fluorine-18 fluorodeoxyglucose PET in infectious bone diseases: results of histologically confirmed cases. Eur J Nucl Med 2000; 27:524–528.

    PubMed  Google Scholar 

  17. Paul R, Ahonen A, Virtama P, Aho A, Ekfors T. F-18 fluorodeoxyglucose—its potential in differentiating between stress-fracture and neoplasia. Clin Nucl Med 1989; 14:906–908.

    CAS  PubMed  Google Scholar 

  18. Schmitz A, Risse JH, Textor J, Zander D, Biersack HJ, Palmedo H. FDG-PET findings of vertebral compression fractures in osteoporosis: preliminary results. Osteoporosis Int 2002; 13:755–761.

    Article  Google Scholar 

  19. De Winter F, Van de Wiele C, Vogelaers D, De Smet K, Verdonk R, Dierckx RA. Fluorine-18 fluorodeoxyglucose-positron emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections. J Bone Joint Surg Am 2001; 83:651–660.

    Google Scholar 

  20. Bury T, Barreto A, Daenen F, Barthelemy N, Ghaye B, Rigo P. Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer. Eur J Nucl Med 1998; 25:1244–1247.

    Article  CAS  PubMed  Google Scholar 

  21. Hsia TC, Shen YY, Yen RF, Kao CH, Changlai SP. Comparing whole body18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diophosphate bone scan to detect bone metastases in patients with non-small cell lung cancer. Neoplasma 2002; 49:267–271.

    CAS  PubMed  Google Scholar 

  22. Wu HC, Yen RF, Shen YY, Kao CH, Lin CC and Lee CC. Comparing whole body18F-2-deoxyglucose positron emission tomography and technetium-99m methylene diphosphate bone scan to detect bone metastases in patients wih renal cell carcinomas—a preliminary report. J Cancer Res Clin Oncol 2002; 128:503–506.

    Article  CAS  PubMed  Google Scholar 

  23. Charkes ND. Skeletal blood flow—Implications for bone scan interpretation. J Nucl Med 1980; 21:91–98.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Bldg, 3400 Spruce Street, Philadelphia, PA 19104, USA

    Hongming Zhuang, Joseph W. Sam, Thomas K. Chacko, Marc Hickeson, Qi Feng, Kozaim Z. Nakhoda, Liang Guan, Phillip Reich, Shirley M. Altimari & Abass Alavi

  2. Laboratório Fleury, Sector de Medicina Nuclear, Rua Cincinato Braga, 282, São Paulo-SP, Brasil

    Paulo S. Duarte

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  1. Hongming Zhuang
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  2. Joseph W. Sam
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  3. Thomas K. Chacko
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  4. Paulo S. Duarte
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  5. Marc Hickeson
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  6. Qi Feng
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  7. Kozaim Z. Nakhoda
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  8. Liang Guan
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  9. Phillip Reich
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  10. Shirley M. Altimari
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  11. Abass Alavi
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Corresponding author

Correspondence to Hongming Zhuang.

Additional information

Some of the data in this paper were orally presented at the 49th Annual Meeting of the Society of Nuclear Medicine, June 15–19, 2002, Los Angeles, Calif., USA.

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Zhuang, H., Sam, J.W., Chacko, T.K. et al. Rapid normalization of osseous FDG uptake following traumatic or surgical fractures. Eur J Nucl Med Mol Imaging 30, 1096–1103 (2003). https://doi.org/10.1007/s00259-003-1198-x

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  • DOI: https://doi.org/10.1007/s00259-003-1198-x

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