Rapid normalization of osseous FDG uptake following traumatic or surgical fractures

Eur J Nucl Med Mol Imaging. 2003 Aug;30(8):1096-103. doi: 10.1007/s00259-003-1198-x. Epub 2003 May 22.

Abstract

It is known that following a traumatic fracture or surgical intervention, bone scintigraphy reveals positive results for an extended period of time, posing a challenge when evaluating patients for possible malignancy or superimposed osteomyelitis. Previous reports indicate that acute fractures can also result in increased fluorine-18 fluorodeoxyglucose (FDG) accumulation and therefore cause difficulties when patients are evaluated for other indications by FDG-PET. The purpose of this study was to assess the pattern and time course of abnormal FDG uptake following traumatic or surgical fracture. A total of 1,517 consecutive patients who underwent whole-body FDG-PET imaging were retrospectively studied. A history of fractures or orthopedic intervention was obtained from an interview prior to scanning. The FDG-PET results were compared with the results of other imaging studies, including bone scans, radiographs, CT, and MRI, as well as surgical pathology reports. Thirty-seven patients with a known date of traumatic or surgical fracture were identified. Among these, 14 had fractures or surgery within 3 months prior to FDG-PET, while 23 had fractures or surgical intervention greater than 3 months prior to FDG-PET. FDG-PET showed no abnormally increased uptake at the known fracture or surgical sites in 30 of these patients. Notably, in the 23 patients with fractures more than 3 months old, all but one showed no abnormally increased uptake. Furthermore, the positive FDG uptake in this exception was a result of complicating osteomyelitis. In the 14 patients with a history of fracture less than 3 months old, only six had abnormally increased FDG uptake. Following traumatic or surgical fractures, FDG uptake is expected to be normal within 3 months unless the process is complicated by infection or malignancy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone and Bones / diagnostic imaging*
  • Bone and Bones / injuries
  • Bone and Bones / metabolism
  • Bone and Bones / surgery*
  • Diagnosis, Differential
  • Female
  • Fluorodeoxyglucose F18* / pharmacokinetics
  • Fractures, Bone / diagnostic imaging*
  • Fractures, Bone / metabolism
  • Humans
  • Male
  • Metabolic Clearance Rate
  • Middle Aged
  • Radiopharmaceuticals / pharmacokinetics
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Time Factors
  • Tomography, Emission-Computed

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18