18F-FDG-PET/CT better localizes active spinal infection than MRI for successful minimally invasive surgery

Nakahara, Mikio; Ito, Manabu; Hattori, Naoya; Magota, Keiichi; Takahata, Masahiko; Nagahama, Ken; Sudo, Hideki; Kamishima, Tamotsu; Tamaki, Nagara; Iwasaki, Norimasa

doi:10.1177/0284185114541983

Cited by 37 publications

(28 citation statements)

References 22 publications

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“…For further evaluation of spondylodiskitis patients, these data may help improve discrimination between infected and noninfected spinal disks. As described by Nakahara et al (13), accurate delineation of areas of active spondylodiskitis infection may also be useful for narrowing the surgical field.…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, 18 F-FDG PET can differentiate active inflammation and degenerative alterations, such as erosive osteochondritis. 18 F-FDG PET/CT or 18 F-FDG PET combined with MRI has been shown to have higher diagnostic accuracy than either modality performed alone (12,13) because the combined modalities can overcome the limited spatial resolution of 18 F-FDG PET and its limited ability to differentiate between inflammation and malignant tissue (3,4,14).…”

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confidence: 99%

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Use of Simultaneous ¹⁸F-FDG PET/MRI for the Detection of Spondylodiskitis

et al. 2016

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The diagnosis of spondylodiskitis is often challenging. MRI is quite sensitive but lacks specificity, and distinction from erosive osteochondritis is often difficult. We sought to assess the diagnostic value of 18 F-FDG PET combined with MRI (combined 18 F-FDG PET/ MRI) in patients with suspected spondylodiskitis and an inconclusive clinical or MRI presentation. Methods: In a prospective study, 30 patients with previous inconclusive MRI results and suspected spondylodiskitis underwent combined 18 F-FDG PET/MRI, including precontrast and postcontrast standard spine MRI sequences. The image datasets were evaluated on dedicated workstations by 2 radiology residents and 1 board-certified nuclear medicine physician independently and then in consensus. Because of severe susceptibility artifacts, only 28 of 30 image datasets were evaluable, with a total of 29 regions of suspected spondylodiskitis. SUV ratios (affected disk/reference disk) were determined. The imaging results were compared with histopathology or clinical follow-up as a reference standard and subjected to statistical analysis. Results: The reference standards identified spondylodiskitis in 12 disks and excluded spondylodiskitis in 17 disks. For MRI alone, the sensitivity was 50%, the specificity was 71%, the positive predictive value was 54%, and the negative predictive value was 67%. Adding the PET data resulted in sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 88%, 86%, and 100%, respectively. In a receiver operating characteristic curve analysis, an SUV max ratio threshold of 2.1 resulted in 92% sensitivity and 88% specificity (area under the receiver operating characteristic curve, 0.95). Neither the level of C-reactive protein nor the leukocyte count at the time of PET/MRI was related to the reference standard diagnosis of spondylodiskitis. Conclusion: In patients with inconclusive clinical or MRI findings, the use of 18 F-FDG PET/MRI significantly increased diagnostic certainty for the detection of spondylodiskitis.

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Section: Discussionmentioning

confidence: 95%

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confidence: 99%

Use of Simultaneous ¹⁸F-FDG PET/MRI for the Detection of Spondylodiskitis

et al. 2016

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“…This additional information influenced patient management (29). Nakahara et al (30) reported that 18 F-FDG PET/CT was superior to MRI for localizing sites of infection and guiding minimally invasive surgery. 18 F-FDG appears useful for monitoring treatment response in spondylodiskitis.…”

Section: Spondylodiskitismentioning

confidence: 99%

Radionuclide Imaging of Musculoskeletal Infection: A Review

Palestro

2016

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the principle of combined labeled leukocyte/marrow imaging; (2) at least one advantage of 18 F-FDG PET or PET/CT over MRI for diagnosing spondylodiskitis; and (3) at least one advantage of SPECT/CT over planar imaging in the diagnosis of pedal osteomyelitis in diabetic patients.Financial Disclosure: The author of this article has indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through September 2019.There are numerous imaging tests for diagnosing musculoskeletal infection. Radiographs are routinely performed, because even when not diagnostic, they provide an anatomic overview of the region of interest that could influence subsequent procedure selection and interpretation. MRI is sensitive and provides superb anatomic detail. Bone scintigraphy accurately diagnoses osteomyelitis in bones not affected by underlying conditions. 67 Ga is used primarily for spondylodiskitis. Although in vitro labeled leukocyte imaging is the radionuclide test of choice for complicating osteomyelitis such as diabetic pedal osteomyelitis and prosthetic joint infection, it is not useful for spondylodiskitis. Antigranulocyte antibodies and antibody fragments have limitations and are not widely available. 111 In-biotin is useful for spondylodiskitis. Radiolabeled synthetic fragments of the antimicrobial peptide ubiquicidin are promising infection-specific agents. 18 F-FDG is the radiopharmaceutical of choice for spondylodiskitis. Its role in diabetic pedal osteomyelitis and prosthetic joint infection is not established. Preliminary data suggest 68 Ga may be useful in musculoskeletal infection. 124 I-fialuridine initially showed promise as an infection-specific radiopharmaceutical, but subsequent investigations were disappointing. The development of PET/CT and SPECT/CT imaging systems, which combine anatomic and functional imaging, has revolutionized diagnostic imaging. These hybrid systems are redefining the diagnostic workup of patients with suspected or known infection and inflammation by improving diagnostic accuracy and influencing patient management.

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“…In the patients with pyogenic spondylitis, 18F-FDG PET/CT has an impact in the extension of therapeutic period, whereas in those with tuberculous spondylitis, it is used to indicate the biopsy sites and to determine which lesions require surgery [38]. In the latter category, 18F-FDG PET/CT seems also to be a useful diagnostic technique for successful surgical planning with accurate localization of the active infection [39].…”

Section: F-fdg Pet/ct For the Assessment Of Treatment Responsementioning

confidence: 99%