IV contrast is not useful because it does not add information in the setting of recent osteoporotic VCF. Bone Scan Whole Body Tc-99m whole-body bone scan (bone scintigraphy) may be helpful to determine the painful vertebrae [52], particularly the causative level [53,54]. Bone scan and MRI have higher concordance with single-level fractures compared with multiple level involvements [55]. When more than one area of increased activity is detected, bone scans may overestimate the number of acute fractures. As such, multiple regions of radiotracer accumulation should be interpreted cautiously [56]. The utilization of bone scans may be based on institutional preference. SPECT or SPECT/CT Spine Area of Interest Single-photon emission computed tomography (SPECT) coupled with CT provides complementary information because sites of abnormal radiopharmaceutical uptake on the spine are of interest. SPECT images can be anatomically localized on the CT, and anatomic abnormalities on CT images can draw attention to subtle areas of SPECT tracer uptake. SPECT/CT has been shown to localize abnormalities in the vertebra more precisely compared with SPECT imaging alone, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [57]. Studies have demonstrated a 63% to 80% agreement between SPECT/CT and MRI in detecting acute VCF [58,59]. Li et al [60] found that SPECT/CT is useful for imaging diagnosis of acute fractures in their study of 46 patients. FDG-PET/CT Skull Base to Mid-Thigh PET using the tracer fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG) combined with morphologic CT imaging can noninvasively localize metabolic activity in areas of spinal infection [61-63]. Vertebral osteomyelitis may present as a compression fracture [64] and may be difficult to distinguish from noninfectious, osteoporotic VCF.
Management of Vertebral Compression Fractures PCAs. IV contrast is not useful because it does not add information in the setting of recent osteoporotic VCF. Bone Scan Whole Body Tc-99m whole-body bone scan (bone scintigraphy) may be helpful to determine the painful vertebrae [52], particularly the causative level [53,54]. Bone scan and MRI have higher concordance with single-level fractures compared with multiple level involvements [55]. When more than one area of increased activity is detected, bone scans may overestimate the number of acute fractures. As such, multiple regions of radiotracer accumulation should be interpreted cautiously [56]. The utilization of bone scans may be based on institutional preference. SPECT or SPECT/CT Spine Area of Interest Single-photon emission computed tomography (SPECT) coupled with CT provides complementary information because sites of abnormal radiopharmaceutical uptake on the spine are of interest. SPECT images can be anatomically localized on the CT, and anatomic abnormalities on CT images can draw attention to subtle areas of SPECT tracer uptake. SPECT/CT has been shown to localize abnormalities in the vertebra more precisely compared with SPECT imaging alone, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [57]. Studies have demonstrated a 63% to 80% agreement between SPECT/CT and MRI in detecting acute VCF [58,59]. Li et al [60] found that SPECT/CT is useful for imaging diagnosis of acute fractures in their study of 46 patients. FDG-PET/CT Skull Base to Mid-Thigh PET using the tracer fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG) combined with morphologic CT imaging can noninvasively localize metabolic activity in areas of spinal infection [61-63]. Vertebral osteomyelitis may present as a compression fracture [64] and may be difficult to distinguish from noninfectious, osteoporotic VCF.