British journal of neurosurgery · 2017
Non traumatic vertebral lesions: incremental utility of PET-CT over MRI and FNAC in a suggested diagnostic algorithm.
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Meena Rajesh, Aggarwal Ashish, Bhattacharya Anish, Gupta Vivek, Dhandapani Sivashanmugam, Chhabra Rajesh
Аннотация
OBJECTIVE: To prospectively compare positron emission tomography-computed tomography (PET-CT) with conventional magnetic resonance imaging (MRI) and FNAC for diagnosis of non- traumatic vertebral lesions fracture in countries like India where tuberculosis is endemic.
METHODS: Fifty four patients with non-traumatic spontaneous vertebral lesions were prospectively studied. All patients underwent CEMRI focusing on the spinal lesions, whole-body PET-CT and FNAC.Results were then analysed and compared with final diagnosis obtained either by FNAC or clinical follow up.
RESULTS: Out of total 54 patients, FNAC from the spinal lesion could establish diagnosis in 36 patients (26 TB, 1 Fungal and 9 tumors). Of the remaining 18 patients, diagnosis could be established in 7 utilizing FNAC from other sites as dictated by PET-CT. In the remanining11 patients, the diagnosis and management was decided on the concordance of MRI and PET-CT.
CONCLUSION: All three investigations have their own advantages and pitfalls and they complement each other in reaching the final diagnosis. MRI has a better pick up rate (than PET-CT) for inflammatory lesions. PET-CT on the other hand has better sensitivity for malignant vertebral disease. Diagnosis was established if FNAC was conclusive. In cases where FNAC was inconclusive, an additional 38.9% patients' diagnosis could be established by FNAC from other sites of involvement as dictated by PET-CT. This was an incremental utility of PET-CT. When even this fails, there were two possible scenarios-MRI and PET-CT in concordance with each other. In such a scenario, the combined report of MRI and PET-CT was relied upon. The last sub group (where MRI and PET-CT were discordant and FNAC was inconclusive) still remains achilles' heel. Wide bore biopsy may help in establishing diagnosis in such group.
METHODS: Fifty four patients with non-traumatic spontaneous vertebral lesions were prospectively studied. All patients underwent CEMRI focusing on the spinal lesions, whole-body PET-CT and FNAC.Results were then analysed and compared with final diagnosis obtained either by FNAC or clinical follow up.
RESULTS: Out of total 54 patients, FNAC from the spinal lesion could establish diagnosis in 36 patients (26 TB, 1 Fungal and 9 tumors). Of the remaining 18 patients, diagnosis could be established in 7 utilizing FNAC from other sites as dictated by PET-CT. In the remanining11 patients, the diagnosis and management was decided on the concordance of MRI and PET-CT.
CONCLUSION: All three investigations have their own advantages and pitfalls and they complement each other in reaching the final diagnosis. MRI has a better pick up rate (than PET-CT) for inflammatory lesions. PET-CT on the other hand has better sensitivity for malignant vertebral disease. Diagnosis was established if FNAC was conclusive. In cases where FNAC was inconclusive, an additional 38.9% patients' diagnosis could be established by FNAC from other sites of involvement as dictated by PET-CT. This was an incremental utility of PET-CT. When even this fails, there were two possible scenarios-MRI and PET-CT in concordance with each other. In such a scenario, the combined report of MRI and PET-CT was relied upon. The last sub group (where MRI and PET-CT were discordant and FNAC was inconclusive) still remains achilles' heel. Wide bore biopsy may help in establishing diagnosis in such group.