Evaluation of Schmorl's nodes using F-18 FDG PET/CT

Area of Science:

• Radiology
• Nuclear Medicine
• Oncology

Background:

• Schmorl's nodes are common vertebral endplate defects.
• Their appearance on imaging can sometimes mimic other pathologies.

Purpose of the Study:

• To evaluate the imaging characteristics of Schmorl's nodes using combined 2-[(18)F]-fluoro-2-deoxy-d-glucose positron-emission tomography/computed tomography (FDG PET/CT).
• To assess the correlation between magnetic resonance imaging (MRI) findings and FDG uptake in Schmorl's nodes.

Main Methods:

• Retrospective analysis of 12 patients with diagnosed Schmorl's nodes who underwent both MRI and FDG PET/CT within one week.
• Comparison of MRI findings (specifically perifocal enhancement) with FDG PET/CT metrics, including maximum standardized uptake value (SUVmax).

Main Results:

• Schmorl's nodes exhibited low to moderate FDG uptake.
• Nodes with perifocal enhancement on MRI showed significantly higher early and delayed SUVmax compared to those without enhancement (p=0.012, p=0.006).
• A non-significant trend suggested a positive correlation between delayed SUVmax and patient age.

Conclusions:

• Schmorl's nodes have characteristic FDG avidity on PET/CT.
• Perifocal enhancement on MRI is associated with increased FDG uptake in Schmorl's nodes.
• Clinicians should consider Schmorl's nodes as a potential source of false-positive findings for bone metastases on FDG PET/CT, particularly in older individuals.