van Rijsewijk N D, Wouthuyzen-Bakker M, van Snick J H, van Sluis J, Duis K Ten, Glaudemans A W J M, IJpma F F A
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Nucl Med Mol Imaging. 2025 Mar 27. doi: 10.1007/s00259-025-07209-y.
Evaluation of bone healing potential in cases of delayed union or non-union remains a challenge. This study evaluated the use of [F]NaF PET/CT to assess bone healing and its role in guiding clinical decision-making in orthopaedic trauma surgery.
From June 2019 to December 2024, a prospective study was conducted in a level 1 trauma center. The study included 18 patients (20 fractures: 15 non-unions, 5 bone defects) all showing impaired bone healing after initial surgical fracture treatment, who were eligible for revision surgery. Dynamic (first 10 min post-tracer injection) and static (1-hour post-injection) [F]NaF PET/CT scans were performed to assess bone healing capacity through qualitative and quantitative analysis. The relationship between scan results and treatment outcome was evaluated.
Increased [F]NaF uptake, suggestive for bone healing capacity, was observed in all fractures (20/20). Based on the positive [F]NaF PET/CT results, watchful waiting was recommended for all fractures, with two patients preferring surgery. After prolonged watchful waiting, 72% (13/18) showed bone healing progression. Notably, atrophic fractures displayed biological activity, and non-unions demonstrated sustained metabolic activity even beyond 12 months. Most fractures requiring revision surgery (80%, 4/5) needed additional stabilization. Ultimately, [F]NaF PET/CT imaging helped to avoid revision surgery in 65% of all fractures (13/20). Uptake pattern analysis suggest that whole-bone uptake could potentially indicate surgical need (χ² = 5.62, p = 0.018). Quantitative assessment provided no additional information.
[F]NaF PET/CT imaging provides valuable insights into bone healing potential, especially in non-unions, helping guide clinical decisions and reducing unnecessary surgeries. This study challenges traditional non-union definitions by highlighting the biological activity of both atrophic and hypertrophic fractures.
评估延迟愈合或不愈合病例的骨愈合潜力仍然是一项挑战。本研究评估了[F]NaF PET/CT在评估骨愈合中的应用及其在指导骨科创伤手术临床决策中的作用。
2019年6月至2024年12月，在一级创伤中心进行了一项前瞻性研究。该研究纳入了18例患者（20处骨折：15例不愈合，5例骨缺损），所有患者在初次手术治疗骨折后均显示骨愈合受损，符合翻修手术条件。进行了动态（注射示踪剂后前10分钟）和静态（注射后1小时）[F]NaF PET/CT扫描，通过定性和定量分析评估骨愈合能力。评估了扫描结果与治疗结果之间的关系。
在所有骨折（20/20）中均观察到[F]NaF摄取增加，提示骨愈合能力。基于[F]NaF PET/CT的阳性结果，建议对所有骨折进行观察等待，有2例患者倾向于手术。经过长时间的观察等待，72%（13/18）显示骨愈合进展。值得注意的是，萎缩性骨折表现出生物活性，不愈合甚至在12个月后仍表现出持续的代谢活性。大多数需要翻修手术的骨折（80%，4/5）需要额外的固定。最终，[F]NaF PET/CT成像帮助65%的所有骨折（13/20）避免了翻修手术。摄取模式分析表明，全骨摄取可能表明手术需求（χ² = 5.62，p = 0.018）。定量评估未提供额外信息。
[F]NaF PET/CT成像为骨愈合潜力提供了有价值的见解，尤其是在不愈合方面，有助于指导临床决策并减少不必要的手术。本研究通过强调萎缩性和肥大性骨折的生物活性，对传统的不愈合定义提出了挑战。
