SNM's Image of the Year Highlights Non-Oncology Utility

June 7, 2011

The Society of Nuclear Medicine’s (SNM) 2011 Image of the Year illustrates the ability of positron emission tomography/computer tomography (PET/CT) scans to identify abnormal bone reaction in patients who have received spinal fixation hardware implants.

Each year, The Society of Nuclear Medicine’s (SNM) chooses an image from it's annual meeting that exemplifiescutting-edge molecular imaging.

The 2011 Image of the Year illustrates the ability of positron emission tomography/computer tomography (PET/CT) scans to identify abnormal bone reaction in patients who have received spinal fixation hardware implants. Researchers selected this image from more than 1,800 studies presented.

Andrew Quon, MD, assistant professor of radiology and chief of clinical PET/CT for the molecular imaging program at Stanford University, Stanford, Calif., and lead author of the study, further noted, “The NaF PET/CT image shows the potential of molecular imaging for helping patients with a very common orthopedic problem, and it is available to patients right now.  It's very exciting because it reminds us that the future of molecular imaging lies not just in cancer imaging but in a wide range of disease processes beyond oncologic applications.”

Serious spinal instability and disease often necessitate the implantation of hardware such as plates, cages, rods and screws or bone grafts to support the spine. There are many reasons why patients experience pain after initial surgery, including hardware failure and infection, or both. Determining the source of pain can be difficult, especially when patients have complex medical histories. In this study, a combination of PET/CT and F-18 NaF, an injected radiotracer that uses sodium fluoride to target “hot spots” or areas of high bone turnover and inflammation during imaging, was used to evaluate patients with back pain after spinal surgery. This form of molecular imaging was shown to be highly accurate in determining the culprit of patient’s chronic pain by highlighting both the structure of the bone and the physiological processes involved in inflammation, an indication of injury and infection.

For this prospective study, 20 patients presenting with spinal pain were evaluated with PET/CT using F-18 NaF at least eight months after surgery. A total of 24 bone or tissue abnormalities were found in 17 of the 20 subjects. Of the original 20 patients, 12 received exploratory surgery and four participants received local anesthetic nerve blockade, a common and minimally invasive treatment that numbs the affected nerve, providing short-term pain management as an alternative to surgery. The research indicates that F-18 NaF PET/CT is highly effective for the evaluation of pain after spinal surgery-in more than 85 percent of cases, this form of molecular imaging was able to identify the exact source of patient’s pain.

REFERENCE from the SNM.org website: Scientific Paper 457: A. Quon, C. Sprinz, M. Rodrigues de Abreu, J. Maria Alves Neto, A. Iagaru, S. Hennermann, Stanford University, Stanford, CA; Hospital Mae de Deus, Porto Alleger, Brazil; "Integrated F18 NaF PET/CT scanning for the evaluation of patients with chronic pain after spinal surgery,?" SNM's 58th Annual Meeting, June 8, 2011, San Antonio, TX.