An exploratory multimodal imaging and clinicopathological strategy for suspected Kümmell's disease in the absence of...

Diagnosing Kümmell's disease (KD) remains a clinical challenge when patients present with contraindications for magnetic resonance imaging (MRI). To address this issue, we propose and make a preliminary attempt at a promising exploratory multimodal diagnostic strategy. It directly combines structural imaging with metabolic data for KD when MRI is contraindicated.

We evaluated suspected KD patients using a stepwise workflow. Following initial clinical symptom screening, patients underwent plain radiography and high-resolution computed tomography (CT) to detect key morphological signs, such as intervertebral vacuum clefts (IVCs) and fracture-end sclerosis. Finally, we utilized ⁹⁹ᵐTc-MDP bone scintigraphy, namely emission computed tomography (ECT), to assess the actual metabolic status of the affected vertebrae.

CT scans provided conclusive anatomical evidence of vertebral injury and instability. ECT scans revealed metabolic activity, identifying lesions with high metabolic activity (hot areas) or decreased radiotracer uptake intensity (cold areas), corresponding to repair processes and avascular necrosis, respectively. The combination of these multimodal examinations provided convergent imaging evidence supportive of the diagnosis of KD.

For KD patients who are not suitable for MRI, a combination of CT and ECT bone imaging may serve as a feasible exploratory diagnostic approach. This technique may help address some limitations of single-modality assessment by linking anatomical information with metabolic activity, contributing to more accurate diagnosis and more informed clinical decision-making.