Assessment of successful incorporation of cages after cervical or lumbar intercorporal fusion with [(18)F]fluoride positron-emission tomography/computed tomography

Fischer, Dorothee ; Zweifel, K. ; Treyer, V. ; Hesselmann, R. ; Johayem, A. ; Stumpe, K. ; von Schulthess, G. ; Hany, T. ; Strobel, K.

In: European Spine Journal, 2011, vol. 20, no. 4, p. 640-648

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    Summary
    The purpose of this study is to assess the successful incorporation of cages in patients after cervical or lumbar intercorporal fusion with positron-emission tomography/computed tomography (PET/CT). Twenty patients (14 female and 6 male; mean age 58years, age range 38-73years) with 30 cervical (n=13) or lumbar (n=17) intercorporal fusions were prospectively enrolled in this study. Time interval between last intercorporal intervention and PET/CT ranged from 2 to 116months (mean 63; median 77months). IRB approval was obtained for all patients, and written informed consent was obtained from all patients. About 30min prior to PET/CT scanning, 97-217MBq (mean 161MBq) 18F-fluoride were administered intravenously. Patients were imaged in supine position on a combined PET/CT system (Discovery RX/STE, 16/64 slice CT, GE Healthcare). 3D-PET emission data were acquired for 1.5 and 2min/bed position, respectively, and reconstructed by a fully 3D iterative algorithm (VUE Point HD) using low-dose CT data for attenuation correction. A dedicated diagnostic thin-slice CT was optionally acquired covering the fused region. Areas of increased 18F-fluoride uptake around cages were determined by one double-board certified radiologist/nuclear physician and one board certified radiologist in consensus. In 12/20 (60%) patients, increased 18F-fluoride uptake around cages was observed. Of the 30 intercorporal fusions, 15 (50%) showed increased 18F-fluoride uptake. Median time between intervention and PET/CT examination in cages with increased uptake was 37months (2-116months), median time between intervention and PET/CT examination in those cages without increased uptake was 91months (19-112months), p (Wilcoxon)=0.01 (one-sided). 14/29 (48%) cages with a time interval>1year between intervention and PET/CT scan showed an increased uptake. In conclusion, PET/CT frequently shows increased 18F-fluoride uptake in cervical and lumbar cages older than 1year (up to almost 8years in cervical cages and 10years in lumbar cages) possibly indicating unsuccessful fusion due to increased stress/microinstability