The Value of Radionuclide Imaging as a Screening Test for the Diagnosis of an Acute Thoracic Spinal Fractures

ABSTRACT

PURPOSE: The diagnosis of acute thoracic spinal fractures is often missed by plain radiography, alone. The purpose of this study was to compare the accuracy of radionuclide imaging with radiography, thoracic for detection of acute thoracic spinal fractures and to propose radionuclide imaging as screening tests for the diagnosis of acute thoracic spinal fractures before thoracic spine CT or MRI. METHODS: Out of the patients who were admitted to our medical center, Emergency Medicine Department for trauma from June 1, 2001, to February 28, 2003. We are retrospectively studied 67 patients who had undergone radionuclide imaging and thoracic MRI to detect acute thoracic spinal fractures. Because of their symptoms those 67 patients were suspected of having thoracic compression fractures, but those fractures had not been detected on plain thoracic spine radiographics. RESULTS: In 19 patients, 43 acute thoracic spinal fractures were detected by thoracic MRI, in 17 patients, 29 acute thoracic spinal fractures were detected by radionuclide imaging (67.4%) and in 11 patients, 14 acute thoracic spinal fractures were detected by radiography, thoracic (32.6%). The diagnostic agreement of radionuclide imaging with thoracic MRI (Kappa=0.771) was higher than that of plain radiography, thoracic with thoracic MRI (Kappa=0.439). The sensitivity, specificity, and accuracy of radionuclide imaging were 67.4%, 100%, and 93.9%, respectively, and those of plain radiography, thoracic were 32.6%, 100%, and 87.3%. The sensitivity and accuracy of radionuclide imaging for the diagnosis of acute thoracic spinal fractures were significantly higher than those of plain radiography, thoracic (p<0.05). CONCLUSION: Radionuclide imaging is more sensitive and accurate in detecting acute thoracic spinal fractures than plain thoracic spine radiography. Further study is required to prove whether radionuclide imaging is a useful screening test for acute thoracic spinal fractures instead of performing expensive thoracic spine CT or MRI.