Can Na18F PET/CT bone scans help when deciding if early intervention is needed in patients being treated with a TSF attached to the tibia: insights from 41 patients

Eur J Orthop Surg Traumatol. 2021 Feb;31(2):349-364. doi: 10.1007/s00590-020-02776-2. Epub 2020 Sep 5.


Purpose: To demonstrate the usefulness of positron emission tomography (PET)/computed tomography (CT) bone scans for gaining insight into healing bone status earlier than CT or X-ray alone.

Methods: Forty-one prospective patients being treated with a Taylor Spatial Frame were recruited. We registered data obtained from successive static CT scans for each patient, to align the broken bone. Radionuclide uptake was calculated over a spherical volume of interest (VOI). For all voxels in the VOI, histograms and cumulative distribution functions of the CT and PET data were used to assess the type and progress of new bone growth and radionuclide uptake. The radionuclide uptake difference per day between the PET/CT scans was displayed in a scatter plot. Superimposing CT and PET slice data and observing the spatiotemporal uptake of 18F- in the region of healing bone by a time-sequenced movie allowed qualitative evaluation.

Results: Numerical evaluation, particularly the shape and distribution of Hounsfield Units and radionuclide uptake in the graphs, combined with visual evaluation and the movies enabled the identification of six patients needing intervention as well as those not requiring intervention. Every revised patient proceeded to a successful treatment conclusion.

Conclusion: Numerical and visual evaluation based on all the voxels in the VOI may aid the orthopedic surgeon to assess a patient's progression to recovery. By identifying slow or insufficient progress at an early stage and observing the uptake of 18F- in specific regions of bone, it might be possible to shorten the recovery time and avoid unnecessary late complications.

Keywords: Complex tibia fractures; NaF-18 bone scans; Orthopedic surgery; PET/CT; Taylor Spatial Frame; Tibia osteotomies.

MeSH terms

  • Humans
  • Positron Emission Tomography Computed Tomography*
  • Positron-Emission Tomography
  • Prospective Studies
  • Tibia* / diagnostic imaging
  • Tomography, X-Ray Computed
  • Tosyl Compounds


  • Tosyl Compounds
  • 4-toluenesulfonyl fluoride