18F-fluorocholine may be able to differentiate between degenerative and malignant osseous abnormalities because degenerative changes are not choline-avid [74]. Prostate-specific membrane antigen (PSMA)-PET imaging has been approved by the FDA in patients with prostate cancer with radioactive agent binding to prostatic cancer cells. Image-Guided Biopsy Spine Area of Interest Percutaneous biopsy is performed to verify the etiology of VCF, especially if imaging findings are equivocal or the fractured vertebra is the only site of involvement in a patient with known malignancy. Biopsy has been shown to confirm clinical suspicion of neoplastic involvement and also aids in directing future treatment planning [75]. Variant 3: New back pain. Previously treated VCF or multiple VCFs. Initial Imaging. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination, guided by physical examination findings, patient history, and other available information, including prior imaging. CT Spine Area of Interest CT provides osseous details of axial spine fractures prior to VA [12,39]. CT permits evaluation of vertebral body height, architecture, and integrity of the posterior cortex and pedicles before VA, which is critical in patients with cortical disruption, posterior cortex osseous retropulsion, epidural extension, and spinal canal compression. CT is also the optimal modality to identify cement leakage in paraspinal, epidural, intravascular, or adjacent discal regions [76,77]. CT also depicts the development of adjacent level fracture in a patient with recent augmentation and new back pain [78]. CT is also useful to evaluate the cause of new pain in patients with surgical intervention with hardware placement. This modality can evaluate a patient with new back pain after undergoing treatment of single- or multiple-level VCFs.
Management of Vertebral Compression Fractures PCAs. 18F-fluorocholine may be able to differentiate between degenerative and malignant osseous abnormalities because degenerative changes are not choline-avid [74]. Prostate-specific membrane antigen (PSMA)-PET imaging has been approved by the FDA in patients with prostate cancer with radioactive agent binding to prostatic cancer cells. Image-Guided Biopsy Spine Area of Interest Percutaneous biopsy is performed to verify the etiology of VCF, especially if imaging findings are equivocal or the fractured vertebra is the only site of involvement in a patient with known malignancy. Biopsy has been shown to confirm clinical suspicion of neoplastic involvement and also aids in directing future treatment planning [75]. Variant 3: New back pain. Previously treated VCF or multiple VCFs. Initial Imaging. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination, guided by physical examination findings, patient history, and other available information, including prior imaging. CT Spine Area of Interest CT provides osseous details of axial spine fractures prior to VA [12,39]. CT permits evaluation of vertebral body height, architecture, and integrity of the posterior cortex and pedicles before VA, which is critical in patients with cortical disruption, posterior cortex osseous retropulsion, epidural extension, and spinal canal compression. CT is also the optimal modality to identify cement leakage in paraspinal, epidural, intravascular, or adjacent discal regions [76,77]. CT also depicts the development of adjacent level fracture in a patient with recent augmentation and new back pain [78]. CT is also useful to evaluate the cause of new pain in patients with surgical intervention with hardware placement. This modality can evaluate a patient with new back pain after undergoing treatment of single- or multiple-level VCFs.