Bone scan in detection of biological activity in nonhypertrophic fracture nonunion

et al. 2020

Preprint

BackgroundRecently, a standardized uptake value (SUV) has been used to evaluate bone single photon emission computed tomography (SPECT). The aim of this study was to investigate quantitative SPECT imaging of uninfected nonunion to compare hypertrophic nonunion and non-hypertrophic nonunion using volume-based parameters.MethodsWe evaluated 23 patients with uninfected nonunion who underwent SPECT acquisition 3 h after an injection of 99mTc-hydroxymethylene diphosphonate or 99mTc-methylene diphosphonate from April 2014 to November 2019. We reconstructed the acquired data and performed voxel-based quantitative analysis using GI-BONE software. Quantitative parameters, maximum SUV (SUVmax), peak SUV (SUVpeak), and mean SUV (SUVmean) in the high and low uptake areas of nonunion were compared between hypertrophic nonunion and non-hypertrophic nonunion. The contralateral limb was used as a control, and the ratios of the quantitative parameters were calculated. ResultsThe values for the quantitative parameters (high uptake area/low uptake area, respectively), SUVmax control ratio (12.13 ± 4.95/6.44 ± 4.71), SUVpeak control ratio (11.65 ± 4.58/6.45 ± 4.64), and SUVmean control ratio (11.94 ± 5.03/6.28 ± 4.95) for hypertrophic nonunion were higher than those for non-hypertrophic nonunion (7.82 ± 4.76/3.41 ± 2.09 (p = 0.065/0.12), 7.56 ± 4.51/3.61 ± 2.23 (p = 0.065/0.22), and 7.59 ± 5.18/3.05 ± 1.91 (p = 0.076/0.23). ConclusionsSUVmax, peak, mean control ratios obtained from bone SPECT images can quantitatively evaluate the biological activity of nonunions and may be an effective evaluation method for treatment decisions, especially the necessity of autologous bone grafting.

Section: Discussionmentioning

confidence: 88%

“…In some cases, biological activity exists around the nonunion without callus in X-ray ndings. Bone scintigraphy is considered an important examination for determining biological activity [8][9][10][11][12]. Uptake in bone scintigraphy re ects blood ow and new bone formation [13,14].…”

Section: Introductionmentioning

confidence: 99%

Quantitative Bone Single Photon Emission Computed Tomography Imaging for Uninfected Nonunion: Comparison of Hypertrophic Nonunion and Non-Hypertrophic Nonunion

Zeng

et al. 2020

Preprint

“…Niikura et al mentioned that poor callus visualization (non-hypertrophic appearance) did not always indicate lack of biological activity; however, it is possible to evaluate the presence of biological activity by bone scintigraphy [12]. Another report indicated that uptake in bone scintigraphy reflects blood flow and new bone formation [13]. Uptake in bone scintigraphy was observed in both two cases, that is why we judged they had sufficient biological activity.…”

Section: Discussionmentioning

confidence: 94%

Minimally invasive plate osteosynthesis for humeral shaft nonunion: A report of two cases

Suda

Annals of Medicine and Surgery

et al. 2019

IntroductionWe treated two cases of humeral shaft nonunion by minimally invasive plate osteosynthesis (MIPO) without autogenous bone grafting.Presntation of caseCase 1: An osteosynthesis with intramedullary nailing (IMN) was performed on a 17-year-old female for a humeral shaft fracture at another hospital; however, bony union was not obtained. We removed the nail and screws, then performed MIPO without autogenous bone grafting. At the final follow-up of 4 years after the surgery, she had obtained full range of motion.Case 2: Osteosynthesis with Rush pins had been performed in a 73-year-old female for a humeral shaft fracture at another hospital. Five months later, a revision surgery using IMN was performed at the same hospital; however, this led to nonunion. We removed the IMN and performed MIPO without autogenous bone grafting. At the final follow-up 2 years after surgery, she had obtained full range of motion.DiscussionThe cause of nonunion is the lack of mechanical instability and/or biological activity. In these cases, from the findings of radiography and bone scintigraphy, mechanical instability was thought to be the primary cause; therefore, in order to enhance stability, we used a locking plate. Because we can see that these cases are biologically active, we decided not to use bone grafting. Both our cases successfully achieved bony union and excellent functional recovery using this method.ConclusionWe performed MIPO without exposure of the nonunion site and autogenous bone grafting in two cases of humeral shaft nonunion, and obtained successful clinical outcomes.

“…In some cases, biological activity exists around the nonunion without callus in X-ray findings. Bone scintigraphy is considered an important examination for determining biological activity [8][9][10][11][12]. Uptake in bone scintigraphy reflects blood flow and new bone formation [13,14].…”

Section: Introductionmentioning

confidence: 99%

Quantitative bone single-photon emission computed tomography imaging for uninfected nonunion: comparison of hypertrophic nonunion and non-hypertrophic nonunion

Zeng

et al. 2021

J Orthop Surg Res

Background Recently, a standardized uptake value (SUV) has been used to evaluate bone single-photon emission computed tomography (SPECT). The aim of this study was to investigate quantitative SPECT imaging of uninfected nonunion to compare hypertrophic nonunion and non-hypertrophic nonunion using volume-based parameters. Methods We evaluated 23 patients with uninfected nonunion who underwent SPECT acquisition 3 h after an injection of 99mTc-hydroxymethylene diphosphonate or 99mTc-methylene diphosphonate from April 2014 to November 2019. We reconstructed the acquired data and performed voxel-based quantitative analysis using the GI-BONE software. Quantitative parameters, maximum SUV (SUVmax), peak SUV (SUVpeak), and mean SUV (SUVmean) in the high and low uptake areas of nonunion were compared between hypertrophic nonunion and non-hypertrophic nonunion. The contralateral limb was used as a control, and the ratios of the quantitative parameters were calculated. Results The values for the quantitative parameters (high uptake area/low uptake area, respectively), SUVmax control ratio (12.13 ± 4.95/6.44 ± 4.71), SUVpeak control ratio (11.65 ± 4.58/6.45 ± 4.64), and SUVmean control ratio (11.94 ± 5.03/6.28 ± 4.95) for hypertrophic nonunion were higher than those for non-hypertrophic nonunion (7.82 ± 4.76/3.41 ± 2.09 (p = 0.065/0.12), 7.56 ± 4.51/3.61 ± 2.23 (p = 0.065/0.22), and 7.59 ± 5.18/3.05 ± 1.91 (p = 0.076/0.23)). Conclusions SUVmax, SUVpeak, and SUVmean control ratios obtained from bone SPECT images can quantitatively evaluate the biological activity of nonunions and may be an effective evaluation method for treatment decisions, especially the necessity of autologous bone grafting.