SPECT/CT has been shown to localize abnormalities in the vertebra more precisely compared to 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]. Bone SPECT/CT can also gauge successful treatment response after VA and adds valuable information for the cause of back pain. [59]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET combined with morphologic CT imaging can noninvasively localize metabolic activity in areas of spinal neoplastic involvement and can differentiate between benign and malignant VCFs, with the caveat that acute osteoporotic fractures can also have a high standardized uptake value on PET/CT imaging. A meta-analysis by Kim et al [73] showed high sensitivity and moderate specificity for the use of FDG-PET/CT to differentiate benign from malignant compression fractures. In a patient with a history of malignancy, PET/CT is routinely included in the paradigm of metastatic disease evaluation workup [61]. Vertebral osteomyelitis may present as a compression fracture [64] and may be difficult to distinguish from noninfectious, osteoporotic VCF. Other potential radiotracers Vertebral Compression Fractures 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.
Management of Vertebral Compression Fractures PCAs. SPECT/CT has been shown to localize abnormalities in the vertebra more precisely compared to 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]. Bone SPECT/CT can also gauge successful treatment response after VA and adds valuable information for the cause of back pain. [59]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET combined with morphologic CT imaging can noninvasively localize metabolic activity in areas of spinal neoplastic involvement and can differentiate between benign and malignant VCFs, with the caveat that acute osteoporotic fractures can also have a high standardized uptake value on PET/CT imaging. A meta-analysis by Kim et al [73] showed high sensitivity and moderate specificity for the use of FDG-PET/CT to differentiate benign from malignant compression fractures. In a patient with a history of malignancy, PET/CT is routinely included in the paradigm of metastatic disease evaluation workup [61]. Vertebral osteomyelitis may present as a compression fracture [64] and may be difficult to distinguish from noninfectious, osteoporotic VCF. Other potential radiotracers Vertebral Compression Fractures 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.