Prospective comparison of whole-body 18F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis

Fuster, David; Tomás, Xavier; Mayoral, María; Soriano, Álex; Manchon, F; Ariza, Carles; Monegal, A.; Granados, Ulises; Garcia, S. Rodriguez; Pons, Françesca

doi:10.1007/s00259-014-2898-0

Cited by 78 publications

(71 citation statements)

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“…Therefore, those authors recommended the use of 18 F-FDG PET when MRI is doubtful or unavailable. Similar accuracies of MRI alone and 18 F-FDG PET/CT for diagnosing spondylodiskitis (81% and 84%, respectively) were also reported in a study by Fuster et al (8). However, that study of 26 prospective patients demonstrated a low specificity (38%) of MRI, reflecting the difficulty in the exclusion of infectious spondylodiskitis.…”

Section: Discussionsupporting

confidence: 76%

“…MRI can depict the anatomic location and the extent of disease and allows the early detection of disk or bone destruction as well as evaluation of the involvement of neural structures (8). The classic MRI findings of spondylodiskitis are hyperintense signal alterations on T2-weighted images or turbo inversion recovery magnitude (TIRM) sequences in the disk space (often with fluid collections), appearing in both adjacent vertebrae as bone marrow and paravertebral soft-tissue edema.…”

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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: Discussionsupporting

confidence: 76%

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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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“…In agreement with all the above-mentioned data, a recent study that compared 18F-FDG PET/CT with MRI for the diagnosis of hematogenous spondylitis in the same cohort of patients ( Fig. 1) revealed significantly lower specificity for the latter, reflecting its difficulty in ruling out infection in patients with degenerative joint disease or previous vertebral fractures [33].…”

Section: The Role Of 18f-fdg Pet/ct In the Diagnosis Of Spinal Infectsupporting

confidence: 85%

“…In addition, new hybrid imaging modalities such as PET/MRI can potentially present with a useful role in spinal spondylodiscitis. In this direction lead also the results of a recent study which reported that the combination of 18F-FDG PET/CT and MRI detected the infection in 100% in patients with spondylodiskitis [33]. Hybrid PET/MRI systems can combine the acquisition of functional data at the molecular level with superior soft tissue resolution and anatomy.…”

Section: Future Trendsmentioning

confidence: 84%

Positron emission tomography in spinal infections

et al. 2015

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“…In an investigation of patients with inconclusive conventional imaging results, the sensitivity, specificity, and accuracy of 18 F-FDG PET/CT were 81.8%, 100%, and 89.5%, respectively, versus 75%, 71.4%, and 74.1%, respectively, for MRI (26). Fuster et al (27) compared 18 F-FDG PET/CT and MRI. Sensitivity and specificity for 18 F-FDG PET/CT were 83% and 88%, respectively, versus 94% and 38%, respectively, for MRI.…”

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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Prospective comparison of whole-body 18F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis

Abstract: Due to its high specificity, (18)F-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.

Cited by 78 publications

References 19 publications

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

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

Positron emission tomography in spinal infections

Radionuclide Imaging of Musculoskeletal Infection: A Review

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Prospective comparison of whole-body 18F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis

Abstract: Due to its high specificity, (18)F-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.

Cited by 78 publications

References 19 publications

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

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

Positron emission tomography in spinal infections

Radionuclide Imaging of Musculoskeletal Infection: A Review

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

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