SPECT or SPECT/CT Spine Area of Interest SPECT/CT has been shown to precisely localize abnormalities in the vertebra, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [57]. However, MRI has a greater sensitivity and specificity for metastasis in specific spine locations [99] and for certain primaries, such as prostate cancer [100]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may demonstrate localized metabolic activity in a neoplastic VCF and in areas of spinal infection [61-63]. MRI features coupled with clinical symptoms may help discern the etiology of a VCF with increased FDG uptake [101]. A meta-analysis study showed high sensitivity and moderate specificity for FDG-PET/CT to differentiate malignant versus benign VCFs [73]. Other potential radiotracers have been described for the early detection of marrow-based metastases, such as 18F-NaF PET/CT, which indicates areas of increased bone turnover and is generally used in the assessment of primary and secondary osseous malignancies, the evaluation of response to treatment, and the clarification of abnormalities on other imaging modalities or clinical data. However, 18F-NaF PET/CT is a highly sensitive method in evaluating bone metastases (eg, prostate cancer). Still, it can be problematic because of low specificity because the tracer accumulates in degenerative and inflammatory bone diseases. 18F- fluorocholine may be able to differentiate between degenerative and malignant osseous abnormalities because degenerative changes are not choline-avid [74]. Image-Guided Biopsy Spine Area of Interest If the imaging features are ambiguous and not definitely in keeping with a pathologic VCF, a biopsy can be performed to verify the etiology. A biopsy of the spine region of interest may be important for staging when isolated spine involvement is the first presentation of metastatic disease.
Management of Vertebral Compression Fractures PCAs. SPECT or SPECT/CT Spine Area of Interest SPECT/CT has been shown to precisely localize abnormalities in the vertebra, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [57]. However, MRI has a greater sensitivity and specificity for metastasis in specific spine locations [99] and for certain primaries, such as prostate cancer [100]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may demonstrate localized metabolic activity in a neoplastic VCF and in areas of spinal infection [61-63]. MRI features coupled with clinical symptoms may help discern the etiology of a VCF with increased FDG uptake [101]. A meta-analysis study showed high sensitivity and moderate specificity for FDG-PET/CT to differentiate malignant versus benign VCFs [73]. Other potential radiotracers have been described for the early detection of marrow-based metastases, such as 18F-NaF PET/CT, which indicates areas of increased bone turnover and is generally used in the assessment of primary and secondary osseous malignancies, the evaluation of response to treatment, and the clarification of abnormalities on other imaging modalities or clinical data. However, 18F-NaF PET/CT is a highly sensitive method in evaluating bone metastases (eg, prostate cancer). Still, it can be problematic because of low specificity because the tracer accumulates in degenerative and inflammatory bone diseases. 18F- fluorocholine may be able to differentiate between degenerative and malignant osseous abnormalities because degenerative changes are not choline-avid [74]. Image-Guided Biopsy Spine Area of Interest If the imaging features are ambiguous and not definitely in keeping with a pathologic VCF, a biopsy can be performed to verify the etiology. A biopsy of the spine region of interest may be important for staging when isolated spine involvement is the first presentation of metastatic disease.