Can Na18F PET/CT bone scans help when deciding if early intervention is needed in patients being treated with a TSF attached to the tibia: insights from 41 patients

• Published in: European journal of orthopaedic surgery & traumatology Vol. 31; no. 2; pp. 349 - 364
• Main Authors: Lundblad, Henrik, Karlsson-Thur, Charlotte, Maguire, Gerald Q., Noz, Marilyn E., Zeleznik, Michael P., Weidenhielm, Lars
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.02.2021; Springer Nature B.V
• Subjects: Medical imaging; Medicine; Medicine & Public Health; Original; Original Article; Patients; Scintigraphy; Surgical Orthopedics; Tomography; Traumatic Surgery; Complex tibia fractures; Taylor Spatial Frame; Tibia osteotomies; Orthopedic surgery; NaF-18 bone scans; PET/CT
• ISSN: 1633-8065; 1432-1068
• DOI: 10.1007/s00590-020-02776-2

Purpose To demonstrate the usefulness of positron emission tomography (PET)/computed tomography (CT) bone scans for gaining insight into healing bone status earlier than CT or X-ray alone. Methods Forty-one prospective patients being treated with a Taylor Spatial Frame were recruited. We registered data obtained from successive static CT scans for each patient, to align the broken bone. Radionuclide uptake was calculated over a spherical volume of interest (VOI). For all voxels in the VOI, histograms and cumulative distribution functions of the CT and PET data were used to assess the type and progress of new bone growth and radionuclide uptake. The radionuclide uptake difference per day between the PET/CT scans was displayed in a scatter plot. Superimposing CT and PET slice data and observing the spatiotemporal uptake of 18 F − in the region of healing bone by a time-sequenced movie allowed qualitative evaluation. Results Numerical evaluation, particularly the shape and distribution of Hounsfield Units and radionuclide uptake in the graphs, combined with visual evaluation and the movies enabled the identification of six patients needing intervention as well as those not requiring intervention. Every revised patient proceeded to a successful treatment conclusion. Conclusion Numerical and visual evaluation based on all the voxels in the VOI may aid the orthopedic surgeon to assess a patient’s progression to recovery. By identifying slow or insufficient progress at an early stage and observing the uptake of 18 F − in specific regions of bone, it might be possible to shorten the recovery time and avoid unnecessary late complications.