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

作者：Buqing Ma, Guanxiong Wang, B Lin, Dongxu Yang, Yijing Fang, Y Zhu, Z L Li, C Y Liu, Jie Ding, J S Li, Haoyang Rao, Bin Mai, Z F Zhang, Guoye Mo, Huizhi Guo, Danqing Guo, Yanhuai Ma, Yuewei Lin, Yongchao Tang, Kai Yuan, Xicheng Zhang, Haishan Li, Y P Li · 发表于：Frontiers in Medicine · 年份：2026 · DOI：10.3389/fmed.2026.1871132 · 研究领域：Spinal Fractures and Fixation Techniques、Infectious Diseases and Tuberculosis、Spondyloarthritis Studies and Treatments

Background 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. Materials and methods 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 99 ᵐTc-MDP bone scintigraphy, namely emission computed tomography (ECT), to assess the actual metabolic status of the affected vertebrae. Results 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. Conclusion 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 limitation...