European Journal of Radiology 51 (2004) 274–278 Sensitivity and specificity of thallium-201 scintigraphy for the diagnosis of malignant vertebral fractures Juliette Thariat a , Michel Toubeau b , Paul Ornetti c , Bruno Coudert d , Alina Berrielo-Riedinger b , Pierre Fargeot d , Christian Tavernier c , François Brunotte b , Jean Francis Maillefert c,* a Department of Radiotherapy, CGF Leclerc, 1 rue Pr Marion, 21000 Dijon, France b Department of Nuclear Medicine, CGF Leclerc, 1 rue Pr Marion, 21000 Dijon, France c Department of Rheumatology, Hˆ opital Général, 3 rue du Fb Raines, 21000 Dijon, France d Department of Medical Oncology, CGF Leclerc, 1 rue Pr Marion, 21000 Dijon, France Received 15 July 2003; received in revised form 19 September 2003; accepted 23 September 2003 Abstract Objective: To evaluate the accuracy of thallium-201 ( 201 TI) scintigraphy in distinguishing a benign from a malignant recent non-traumatic vertebral fracture. Methods: Study design—Single center, prospective study. Participants—Patients hospitalized for a recent non-traumatic vertebral fracture. Evaluation—Usual clinical, laboratory and radiological assessment; 201 TI vertebral scintigraphy: patients were injected with iv 3 mCi 201 TI. Early and delayed images of the fractured vertebra were obtained. Data analysis—(1) Two examinators, unaware of the other findings, rated the images as hyperfixation or not of the fractured vertebra; (2) the ratio (average count per pixel of the fractured vertebra/normal adjacent vertebrae) were calculated. The final diagnosis was established on the result of vertebral biopsy or on follow-up. Results: Twenty-one patients were included. The final diagnosis was a benign vertebral fracture in 14 patients and a malignant vertebral fracture in 7. The sensitivity, specificity, positive and negative predictive values for a malignant fracture on early 201 TI vertebral scintigraphy images were 28.6, 92.9, 66.6, and 72.2%, respectively, and on delayed images were 28.6, 100, 100, and 73.7%, respectively. The ratio of lesioned over normal tissue was not increased in malignant, compared with benign fractures. Conclusion: The weak sensitivity does not support the wide use of 201 TI bone scintigraphy to distinguish a benign from a malignant recent non traumatic vertebral fracture. However, the high specificity suggests that such evaluation might be proposed prior to vertebral biopsy in some difficult cases. © 2003 Elsevier Ireland Ltd. All rights reserved. Keywords: Diagnosis; Scintigraphy; Thallium-201; Vertebral fracture; Bone metastase; Osteoporosis 1. Introduction Physicians may experience difficulties in differentiating benign from malignant recent vertebral fractures. Anamne- sis, past medical history, physical examination, laboratory tests, X-rays, usually stand for strong presumption. Never- theless, in some cases, the diagnosis remains uncertain. In such cases, bone technetium-99 hydroxymethylene diphos- phonate (Tc-99 HMDP) scintigraphy, and/or magnetic reso- nance imaging (MRI) are performed for more information. On bone Tc-99 HMDP scintigraphy, multiple increased up- takes are often considered as suspect of malignancy, while * Corresponding author. Tel.: +33-3-80-29-37-45; fax: +33-3-80-29-36-78. E-mail address: jean-francis.maillefert@chu-dijon.fr (J.F. Maillefert). a solitary increased uptake of the fractured vertebra is ob- served in most recent benign and malignant fractures [1]. MRI has been reported as a powerful tool for vertebral imaging, showing indirect signs of high value for malig- nant bone diseases, such as soft tissues invasion. However, in some cases, MRI fails to differentiate benign from malig- nant recent vertebral fractures [2,3]. Consequently, in some patients, a vertebral biopsy is needed. Thus, imaging pro- cedures that allow specific and sensitive differentiation be- tween benign and malignant recent vertebral fracture should be useful, particularly in patients with a past medical history of osteophilic neoplasm. These patients may be considered cured or on remission on treatment further to normal clini- cal, laboratory and imaging evaluations. Yet a neoplastic re- currence should be suspected in such patients with a recent vertebral fracture. 0720-048X/$ – see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2003.09.014