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High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI.

Fischer DR, Pfirrmann CW, Zubler V, Stumpe KD, Seifert B, Strobel K, Tamborrini G, von Schulthess GK, Michel BA, Ciurea A - EJNMMI Res (2012)

Bottom Line: The corresponding kappa values for the MRI modality were 0.64 and 0.93, respectively.More spinal lesions were detected by MRI in comparison to PET/CT (68 vs. 38), whereas a similar number of SIJ quadrants scored positive in both modalities (19 vs. 17).Analysis of agreement of lesion detection between both imaging modalities yielded a kappa value of only 0.25 for spinal lesions and of 0.64 for SIJ lesions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland. dorothee.fischer@usz.ch.

ABSTRACT

Background: This study compares the frequency and distribution of increased activity on 18 F-fluoride PET/CT with the presence of bone marrow edema on whole-body MR imaging in the spine and sacroiliac joints (SIJ) of patients with active ankylosing spondylitis (AS).

Methods: Ten patients (6 men and 4 women), between 30 and 58 years old (median 44) with active AS, were prospectively examined with both whole-body MRI and 18 F-fluoride PET/CT. Patients fulfilled modified NY criteria and had a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 4. Increased radiotracer uptake in PET/CT and bone marrow edema in whole-body MRI of spine and SIJ was evaluated independently by two blinded observers for each modality. Kappa statistics were used to compare interobserver agreement as well as scores of consensus reading of the two imaging modalities.

Results: Analysis of interobserver agreement for PET/CT yielded a kappa value of 0.68 for spinal lesions and of 0.88 for SIJ lesions. The corresponding kappa values for the MRI modality were 0.64 and 0.93, respectively. More spinal lesions were detected by MRI in comparison to PET/CT (68 vs. 38), whereas a similar number of SIJ quadrants scored positive in both modalities (19 vs. 17). Analysis of agreement of lesion detection between both imaging modalities yielded a kappa value of only 0.25 for spinal lesions and of 0.64 for SIJ lesions.

Conclusion: Increased 18 F-fluoride uptake in PET/CT is only modestly associated with bone marrow edema on MRI in the spine and SIJ of patients with AS, suggesting different aspects of bone involvement in AS.

No MeSH data available.


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Forty-four-year-old male patient (patient number 9). Patient with an u-aCIL L4, L5 on MRI (arrows) without corresponding increased activity on F PET/CT (arrowheads). Sagittal STIR (a), fused PET/CT (b), CT (c), and PET (d) images.
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Figure 1: Forty-four-year-old male patient (patient number 9). Patient with an u-aCIL L4, L5 on MRI (arrows) without corresponding increased activity on F PET/CT (arrowheads). Sagittal STIR (a), fused PET/CT (b), CT (c), and PET (d) images.

Mentions: Only 14 spine lesions were recorded concordantly by both methods (MRI and F PET/CT): 6 vertebral body lesions and 8 lesions within the posterior spine structures. Twenty-four spinal lesions detected by F PET/CT had no inflammatory character on MRI, while only a minority of them corresponded to fatty changes on T1-weighted MRI sequences (data not shown). A total of 54 acute inflammatory lesions on MRI showed no increased activity on F PET/CT imaging (Table 4). An example is shown in Figure 1. Analysis of consensus reading of PET/CT and MRI with regard to agreement of spinal lesion detection between both imaging modalities yielded a kappa value of only 0.25. Some lesions detected may be the consequence of concurrent degenerative spine disease as exemplified in Figure 2.


High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI.

Fischer DR, Pfirrmann CW, Zubler V, Stumpe KD, Seifert B, Strobel K, Tamborrini G, von Schulthess GK, Michel BA, Ciurea A - EJNMMI Res (2012)

Forty-four-year-old male patient (patient number 9). Patient with an u-aCIL L4, L5 on MRI (arrows) without corresponding increased activity on F PET/CT (arrowheads). Sagittal STIR (a), fused PET/CT (b), CT (c), and PET (d) images.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3472173&req=5

Figure 1: Forty-four-year-old male patient (patient number 9). Patient with an u-aCIL L4, L5 on MRI (arrows) without corresponding increased activity on F PET/CT (arrowheads). Sagittal STIR (a), fused PET/CT (b), CT (c), and PET (d) images.
Mentions: Only 14 spine lesions were recorded concordantly by both methods (MRI and F PET/CT): 6 vertebral body lesions and 8 lesions within the posterior spine structures. Twenty-four spinal lesions detected by F PET/CT had no inflammatory character on MRI, while only a minority of them corresponded to fatty changes on T1-weighted MRI sequences (data not shown). A total of 54 acute inflammatory lesions on MRI showed no increased activity on F PET/CT imaging (Table 4). An example is shown in Figure 1. Analysis of consensus reading of PET/CT and MRI with regard to agreement of spinal lesion detection between both imaging modalities yielded a kappa value of only 0.25. Some lesions detected may be the consequence of concurrent degenerative spine disease as exemplified in Figure 2.

Bottom Line: The corresponding kappa values for the MRI modality were 0.64 and 0.93, respectively.More spinal lesions were detected by MRI in comparison to PET/CT (68 vs. 38), whereas a similar number of SIJ quadrants scored positive in both modalities (19 vs. 17).Analysis of agreement of lesion detection between both imaging modalities yielded a kappa value of only 0.25 for spinal lesions and of 0.64 for SIJ lesions.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, Zurich, CH-8091, Switzerland. dorothee.fischer@usz.ch.

ABSTRACT

Background: This study compares the frequency and distribution of increased activity on 18 F-fluoride PET/CT with the presence of bone marrow edema on whole-body MR imaging in the spine and sacroiliac joints (SIJ) of patients with active ankylosing spondylitis (AS).

Methods: Ten patients (6 men and 4 women), between 30 and 58 years old (median 44) with active AS, were prospectively examined with both whole-body MRI and 18 F-fluoride PET/CT. Patients fulfilled modified NY criteria and had a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 4. Increased radiotracer uptake in PET/CT and bone marrow edema in whole-body MRI of spine and SIJ was evaluated independently by two blinded observers for each modality. Kappa statistics were used to compare interobserver agreement as well as scores of consensus reading of the two imaging modalities.

Results: Analysis of interobserver agreement for PET/CT yielded a kappa value of 0.68 for spinal lesions and of 0.88 for SIJ lesions. The corresponding kappa values for the MRI modality were 0.64 and 0.93, respectively. More spinal lesions were detected by MRI in comparison to PET/CT (68 vs. 38), whereas a similar number of SIJ quadrants scored positive in both modalities (19 vs. 17). Analysis of agreement of lesion detection between both imaging modalities yielded a kappa value of only 0.25 for spinal lesions and of 0.64 for SIJ lesions.

Conclusion: Increased 18 F-fluoride uptake in PET/CT is only modestly associated with bone marrow edema on MRI in the spine and SIJ of patients with AS, suggesting different aspects of bone involvement in AS.

No MeSH data available.


Related in: MedlinePlus