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1 Department of Medical Radiology, Nuclear Medicine, University Hospital,
Ramistr. 100, CH-8091 Zurich, Switzerland.
2 Department of Radiology, Orthopedic University Hospital Balgrist, Forchstr.
340, CH-8008 Zurich, Switzerland.
3 Department of Diagnostic Radiology, University Hospital, Zurich,
Switzerland.
4 Department of Orthopedic Surgery, Orthopedic University Hospital Balgrist,
Zurich, Switzerland.
OBJECTIVE. The objective of our study was to evaluate the usefulness of FDG positron emission tomography (PET) for the differentiation of degenerative and infectious endplate abnormalities in the lumbar spine that were detected on MR imaging.
SUBJECTS AND METHODS. FDG PET was performed prospectively in 30
consecutive patients with substantial endplate abnormalities (craniocaudal
diameter of bone marrow abnormalities, 
25% of vertebral height) found
during MR imaging of the lumbar spine. Both the MR and PET images were
evaluated by two experienced musculoskeletal radiologists and two experienced
nuclear physicians. The diagnosis of either degeneration with different types
of endplate abnormalities or disk-space infection was determined. Clinical
follow-up and, in selected cases, bone biopsies with cultures were used as the
standard of reference.
RESULTS. On the MR images, 25 of the 38 degenerated levels were classified as Modic type I, 13 levels as type II, and none as type III. Five disk-space infections were diagnosed in four patients. MR imaging findings were false-positive at one disk level with type I abnormalities and false-negative at two levels with infection. PET did not show FDG uptake in the intervertebral spaces of any patient with degenerative disease. FDG PET findings were true-positive in all five levels with disk-space infection. The sensitivity and specificity for MR imaging in detecting disk-space infection were 50% and 96%, and were 100% and 100% for FDG PET, respectively (not significant, McNemar test, p = 0.5).
CONCLUSION. Our findings suggest that FDG PET may prove useful for differentiation of degenerative and infectious endplate abnormalities detected on MR imaging. Even in active (Modic type I) degenerative endplate abnormalities in our series, PET did not show increased FDG uptake.
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