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J Nucl Med. 2012; 53 (Supplement 1):536
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General Clinical Specialties

Musculoskeletal: Assessment of the Joint

Role of 18F-Fluoride PET-CT scan in the diagnosis of avascular necrosis (AVN) of femoral head

Shankaramurthy Gayana1, Anish Bhattacharya1, Ramesh Sen2, Manohar Kuruva1, Kanhaiyalal Agrawal1, Raghava Kashyap1 and Bhagwant Mittal1

1 Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India 2 Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Abstract No. 536

Objectives: To evaluate the role of 18F-Fluoride PET-CT scan in the diagnosis of avascular necrosis (AVN) of femoral head

Methods: 20 patients (17male) with clinically high probability of AVN of femoral head were prospectively evaluated. All patients underwent 18F-Fluoride PET-CT scan and MRI of bilateral hip joints. Photopenic area surrounded by areas of reactive increased tracer uptake along with asterisk sign and crescent sign on CT were included as diagnostic criteria for AVN. SUVmax of the photopenic area, affected femoral head, normal femoral head (in case of unilateral AVN) and L5 vertebra were noted. 5 diagnosed patients of AVN of femoral head who underwent joint preserving procedures (core decompression, core decompression + fibular grafting or stem cell infiltration) also underwent 18F-Fluoride PET-CT scan.

Results: 16 patients had AVN of femoral head (8 bilateral) diagnosed on MRI, 2 were diagnosed as transient osteoporosis of hip and 1 with degenerative arthritis. One patient suspicious for AVN on MRI was diagnosed as early AVN on F-18 PET/CT. 18F-Fluoride PET-CT scan correctly diagnosed AVN in all the 16 patients (8 bilateral) detected on MRI. Kappa test showed excellent agreement between between these two modalties (k=0.946). Mean SUVmax was 0.9 (range 0.5-2.1) and 2.3 (range 1.9-5.9) in affected and unaffected hips respectively. In 5 patients who underwent 18F-Fluoride PET-CT scan following joint preserving procedure showed reparative changes and did not show definite photopenic area. While these patients had improved clinically (clinical assessment based on Harris hip score), MRI features suggested persistent AVN changes.

Conclusions: 18F Fluoride PET/CT can be useful in patients with equivocal MRI findings as well as in patients with contra-indications for MRI like cardiac pacemakers, intracranial clips. It can also depict revascularization changes earlier than MRI with good correlation with clinical scores used to assess improvement





This Article
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Google Scholar
Right arrow Articles by Gayana, S.
Right arrow Articles by Mittal, B.
PubMed
Right arrow Articles by Gayana, S.
Right arrow Articles by Mittal, B.