Abstract
Purpose
To prospectively compare 18F-FDG PET/CT and MRI in the diagnosis of haematogenous spondylodiscitis
Methods
The study included 26 patients (12 women, 14 men; mean age 59 ± 17 years) with clinical symptoms of infection of the spine. Patients who had had prior spinal surgery or any type of antibiotic therapy in the previous 3 months were excluded from the study. Whole-body PET/CT 60 min after injection of 4.07 MBq/kg of 18F-FDG and an MRI scan of the spine was performed in all patients. SUVmax in an area surrounding the lesions with the suspicion of infection as well as a background SUVmean in a preserved area of the spine were calculated for quantification. Infection was diagnosed by microbiological documentation in cultures of image-guided spinal puncture fluid or blood. Infection was excluded if symptoms were absent without antimicrobial therapy during a follow-up of at least 6 months.
Results
Spondylodiscitis was confirmed in 18 of the 26 patients. Staphylococcus aureus was found in 8 patients, Mycobacterium tuberculosis in 4, Escherichia coli in 2 and other pathogens in 4. Of the remaining 8 patients, the diagnoses were degenerative spondyloarthropathy in 5 and vertebral fracture in 3. The sensitivity, specificity, and positive and negative predictive value were 83 %, 88 %, 94 % and 70 % for 18F-FDG PET/CT, and 94 %, 38 %, 77 % and 75 % for MRI, respectively. The accuracies of 18F-FDG PET/CT and MRI were similar (84 % and 81 %, respectively). The combination of 18F-FDG PET/CT and MRI detected the infection in 100 % of the patients with spondylodiscitis. 18F-FDG uptake, quantified in terms of SUVmax corrected by the background SUVmean, was significantly higher in patients with spondylodiscitis than in those without infection (p < 0.001).
Conclusion
Due to its high specificity, 18F-FDG PET/CT should be considered as a first-line imaging procedure in the diagnosis of spondylodiscitis. Quantification of uptake in terms of SUVmax was able to discriminate infection of the spine from other processes in this series of patients.
Similar content being viewed by others
References
Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. 2008;56:401–12.
Khan IA, Vaccaro AR, Zlotolow DA. Management of vertebral diskitis and osteomyelitis. Orthopedics. 1999;22:758–65.
Varma R, Lander P, Assaf A. Imaging of pyogenic infectious spondylodiscitis. Radiol Clin North Am. 2001;39:203–13.
Hopkinson N, Stevenson J, Benjamin S. A case ascertainment study of septic discitis: clinical, microbiological and radiological features. Q J Med. 2001;94:465–70.
An HS, Seldomridge JA. Spinal infections. Clin Orthop Relat Res. 2006;444:27–33.
Jung NY, Jee WH, Ha KY, Park CK, Byun JY. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol. 2004;182:1405–10.
Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS. MR imaging assessment of the spine: infection or an imitation? Radiographics. 2009;29:599–612.
Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, et al. Vertebral osteomyelitis: Assessment using MR. Radiology. 1985;157:157–66.
Gemmel F, Rijk PC, Collins JM, Parlevliet T, Stumpe KD, Palestro CJ. Expanding role of 18F-fluoro-D-deoxyglucose PET and PET/CT in spinal infections. Eur Spine J. 2010;19:540–51.
Ito K, Kubota K, Morooka M, Hasuo K, Kuroki H, Mimori A. Clinical impact of (18)F-FDG PET/CT on the management and diagnosis of infectious spondylitis. Nucl Med Commun. 2010;31:691–8.
Treglia G, Focacci C, Caldarella C, Mattoli MV, Salsano M, Taralli S, et al. The role of nuclear medicine in the diagnosis of spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16:20–5.
Gratz S, Dörner J, Oestmann JW, Opitz M, Behr T, Meller J, et al. 67Ga-citrate and 99Tcm-MDP for estimating the severity of vertebral osteomyelitis. Nucl Med Commun. 2000;21:111–1120.
Adatepe MH, Powell OM, Isaacs GH, Nichols K, Cefola R. Hematogenous pyogenic vertebral osteomyelitis: diagnostic value of radionuclide bone imaging. J Nucl Med. 1986;27:1680–5.
Fuster D, Sola O, Soriano A, Monegal A, Setoain X, Tomas X, et al. A prospective study comparing whole-body FDG PET/CT to combined planar bone scan with 67Ga SPECT/CT in the diagnosis of spondylodiskitis. Clin Nucl Med. 2012;37:827–32.
Stumpe KD, Zanetti M, Weishaupt D, Hodler J, Boos N, Von Schultness GK. FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol. 2002;179:1151–7.
De Winter F, Gemmel F, Van De Wiele C, Poffijn B, Uyttendaele D, Dierckx R. 18-Fluorine fluorodeoxyglucose positron emission tomography for the diagnosis of infection in the postoperative spine. Spine. 2003;28:1314–9.
Guhlmann A, Brecht-Krauss D, Suger G, Glatting G, Kotzerke J, Kinzl L, et al. Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis. J Nucl Med. 1998;39:2145–52.
Schmitz A, Kälicke T, Willkomm P, Grünwald F, Kandyba J, Schmitt O. Use of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography in assessing the process of tuberculous spondylitis. J Spinal Disord. 2000;13:541–4.
Vanninen E, Laitinen T, Partanen K, Tulla H, Herno A, Kröger H. Late correlative imaging findings of previous acute infective spondylitis. Clin Nucl Med. 2000;25:779–84.
Skanjeti A, Penna D, Douroukas A, Cistaro A, Arena V, Leo G, et al. PET in the clinical work-up of patients with spondylodiscitis: a new tool for the clinician? Q J Nucl Med Mol Imaging. 2012;56:569–76.
Gratz S, Dörner J, Fischer U, Behr T, Béhé M, Altenvoerde G, et al. 18F-FDG hybrid PET in patients with suspected spondylitis. Eur J Nucl Med Mol Imaging. 2002;29:516–24.
Hungenbach S, Delank KS, Dietlein M, Eysel P, Drzezga A, Schmidt MC. 18F-fluorodeoxyglucose uptake pattern in patients with suspected spondylodiscitis. Nucl Med Commun. 2013;34:1068–74.
Cheung WY, Luk KD. Pyogenic spondylitis. Int Orthop. 2012;36:397–404.
Ohtori S, Suzuki M, Koshi T, Yamashita M, Yamauchi K, Inoue G, et al. 18F-fluorodeoxyglucose-PET for patients with suspected spondylitis showing Modic change. Spine. 2010;15:1599–603.
Domínguez ML, Lorente R, Rayo JI, Serrano J, Sanchez R, Infante JR, et al. SPECT-CT with 67Ga-citrate in the management of spondylodiscitis. Rev Esp Med Nucl Imagen Mol. 2012;31:34–9.
Acknowledgments
This work was supported by AGAUR 2009 SGR 1049.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fuster, D., Tomás, X., Mayoral, M. et al. Prospective comparison of whole-body 18F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 42, 264–271 (2015). https://doi.org/10.1007/s00259-014-2898-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-014-2898-0