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FDG-PET may help to accurately distinguish between benign and malignant vertebral compression fractures, a small study suggests. "FDG-PET may help to accurately distinguish between benign and malignant vertebral compression fractures," a small study suggests [1].

While CT and MRI are often used for this purpose, they do not always lead to a definitive diagnosis. Furthermore this differentiation may be particularly difficult in the elderly, who more often have a history of malignancy as well as being susceptible to osteoporosis.

Researchers looked at the findings of whole-body FDG-PET and FDG-PET/CT in 33 patients with compression fractures, aged 48 to 93 years. Twenty-nine had a history of malignancy. Forty-three compression fractures were identified; 22 thoracic and 21 lumbar.

Patients were followed up with biopsy or clinically, with repeat imaging. Of the 43 compression fractures, 29 were benign and 14 malignant.

On the basis of FDG-PET imaging, 26 of the 43 compression fractures were classified as benign and 17 as malignant. Sensitivity and specificity for differentiating benign from malignant lesions were 86 and 83 per cent, respectively. The positive predictive value was 84 per cent and the negative predictive value, 71 per cent.

The authors noted that PET and PET/CT were equally sensitive, although PET/CT allowed for better fracture localization.

They concluded: "FDG-PET is a useful method of differentiating between benign and malignant compression fractures and can serve as a problem solver in cases of equivocal MRI or CT findings, and in patients who are unable to undergo MRI."

However, the study group added: "We do not recommend FDG-PET as a screening test, but rather as an additional imaging modality in problem cases, particularly in elderly patients with osteoporosis and a history of malignancy."


[1] Use of FDG-PET in differentiating benign from malignant compression fractures
Skeletal Radiol 2008;37:405-413"