BACKGROUND: Although flourine-18-flourodeoxyglucose (FDG) positron emission tomography (PET) has a limitation for localizing anatomical structures, combining it with computed tomography (CT) has made it more efficient for overcoming such limitations. This study aims to evaluate the efficacy of PET/CT for evaluating diseases of the shoulder. METHODS: Retrospective examination was performed on 25 patients who underwent FDG-PET/CT scanning. All the patients were over 60 years of age, and they were evaluated both clinically and radiologically for shoulder pain. The study period was from May, 2006 to May, 2008. One of the patients had metastatic lesion in a shoulder and this patient was excluded from the study, so the total number of subjects in the study was finally 24 patients. RESULTS: PET/CT showed 67% sensitivity, 73% specificity, a positive predictive value of 60%, a negative predictive value of 79%, 27% false positivity and 33% false negativity concerning shoulder pain. PET/CT showed negative finding in 4 cases that were successfully treated by operative treatment (rotator cuff tear [RCT], 3 cases; impingement syndrome, 1 case). Negative findings were also noted in 6 cases in which the pain subsided after conservative treatment (RCT, 1 case; suspected RCT, 2 cases; impingement syndrome, 3 cases). All the patients with osteoarthritis and rheumatoid arthritis had positive findings on PET/CT scanning. CONCLUSIONS: PET/CT is a useful adjunct to the existing imaging modalities to assess functional and pathophysiologic processes and at a very early stage, and so PET/CT can help physicians make better preoperative and postoperative decisions on treatment.
Aged ; Bursitis/radiography/radionuclide imaging ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Joint Diseases/*radiography/*radionuclide imaging ; Male ; Middle Aged ; *Positron-Emission Tomography ; Predictive Value of Tests ; Radiopharmaceuticals/*diagnostic use ; Rotator Cuff/injuries/radiography/radionuclide imaging ; Sensitivity and Specificity ; Shoulder Joint/*radiography/*radionuclide imaging ; *Tomography, X-Ray Computed

OBJECTIVE: Insufficiency fracture (IF) occurs when normal or physiological muscular activity stresses a bone that is deficient in mineral or elastic resistance. We studied clinical characteristics of IF in patients with chronic inflammatory joint diseases in Korea. METHODS: Between Aug. 1997 and Feb. 2003, thirty five patients with 77 fractures were studied at the authors' institution when they were being treated for their rheumatic diseases. The clinical and laboratory data were collected by review of medical record retrospectively. RESULTS: All patients except four were postmenopausal women (mean age 63.0+/-10.0 years) with long disease duration (mean 14.2+/-11.6 years). Thirty three patients had rheumatoid arthritis, 1 ankylosing spondylitis and 1 systemic lupus erythematosus. Twenty nine patients (85.7%) were receiving regular steroid treatment (mean dose 4.0+/-2.3 mg/day, mean duration 6.1+/-4.2 years). Twenty four patients were treated with methotrexate. The significant reduction in their bone mineral density was found 27 patients based on BMD or QCT. Eight patients without osteoporosis were treated with steroid or MTX. Twenty three patients were ever used for osteoporosis treatment. Most patients except four presented with pain in the low back, groin, hip, pelvic, leg and knee. Initial simple radiography was positive in only 7 patients, with vertebral compression fracture in 11 patients and no effect on mobility except ten. Diagnosis was delayed (mean duration of symptom until diagnosis was 45.6+/-64.5 days). IF was confirmed using the bone scan. Sacrum and pelvic bone was most frequently affected site. The other sites were SI joint, iliac wing, symphysis pubis, acetabulum and femur neck. Twenty nine patients required in-patient stay (mean 17.4 days). All but one patient showed an uneventful recovery with conservative treatment. CONCLUSION: The low grade nature of symptoms, minimal effect on mobility, absence of significant trauma and missed on initial plain radiography make diagnosis difficult and delayed. IF should be suspected in cases of unexplained pain with local tenderness in patients of chronic inflammatory joint diseases. The technetium-99m diphosphonate bone scintigraphy was valuable diagnostic tool in the early recognition of IF.
Acetabulum ; Arthritis, Rheumatoid ; Bone Density ; Diagnosis ; Female ; Femur Neck ; Fractures, Compression ; Fractures, Stress* ; Groin ; Hip ; Humans ; Joint Diseases* ; Joints* ; Knee ; Korea ; Leg ; Lupus Erythematosus, Systemic ; Medical Records ; Methotrexate ; Osteoporosis ; Pelvic Bones ; Radiography ; Radionuclide Imaging ; Retrospective Studies ; Rheumatic Diseases ; Sacrum ; Spondylitis, Ankylosing