Differential diagnostic value of 18F-FDG PET/CT for benign and malignant vertebral compression fractures

Objective To investigate the differential diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT for benign and malignant vertebral compression fractures in patients with malignant tumor. Methods From August 2007 to July 2016, 79 patients with vertebral compression fractures were enrolled. Patients were divided into 3 groups based on clinical follow-up or pathological results: osteoporosis group (n=40; 13 males, 27 females, median age: 77 years), metastasis group (n=27; 18 males, 9 females, median age: 64 years) and myeloma group (n=12; 7 males, 5 females, median age: 67.5 years). Characteristics of 18F-FDG PET/CT imaging and maximum standardized uptake value (SUVmax) of involved vertebrae were compared using χ2 test, one-way analysis of variance and the least significant difference t test. SUVmax of normal L2 vertebral body was regarded as the control. Results (1) There were 53, 41 and 16 compression fractures identified in osteoporosis group, metastasis group and myeloma group, respectively. No paravertebral soft tissue mass or spinal accessory involvement was found in osteoporosis group. In metastasis group, 14(34.15%, 14/41) paravertebral soft tissue masses and 28 spinal accessory involvements (68.29%, 28/41) were detected, and the numbers were 2(2/16) and 16(16/16) for myeloma group respectively. There were significant differences for paravertebral soft tissue masses and spinal accessory involvements among 3 groups (χ2 values: 21.75, 73.10, both P 0.05). Conclusions Strip-like 18F-FDG accumulation, SUVmax of vertebral body, paravertebral soft tissue masses and spinal accessory involvements in 18F-FDG PET/CT imaging are important for differential diagnosis of benign and malignant compression fractures. Key words: Fractures, compression; Diagnosis, differential; Positron-emission tomography; Tomography, X-ray computed; Deoxyglucose