A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis

Abstract

PurposeThe purpose of this study was to evaluate the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT scan) and magnetic resonance imaging (MRI) in diagnosing spondylodiscitis and its complications, such as epidural and paraspinal abscesses.MethodsFrom January 2006 to August 2013 patients with a clinical suspicion of spondylodiscitis, with an infection, or with fever of unknown origin were retrospectively included if 18F-FDG-PET/CT and MRI of the spine were performed within a 2-week time span. Imaging results were compared to the final clinical diagnosis and follow-up data were collected.ResultsSixty-eight patients were included of whom 49 patients were diagnosed with spondylodiscitis. MRI showed an overall sensitivity of 67 % and specificity of 84 %. Diagnostic accuracy was 58 %, when MRI was performed within 2 weeks after the start of symptoms and improved to 82 %, when performed more than 2 weeks after onset of symptoms. 18F-FDG-PET/CT showed a sensitivity of 96 % and a specificity of 95 %, with no relation to the interval between the scan and the start of symptoms.ConclusionsAs compared to MRI, 18F-FDG-PET/CT has superior diagnostic value for detecting early spondylodiscitis. After 2 weeks both techniques perform similarly.

Spondylodiscitis following endovascular abdominal aortic aneurysm repair: imaging perspectives from a single centre’s experience

“…These examples highlight the potential role of 18 F-FDG PET/CT, not just for diagnosis, but also as an effective means of monitoring the progress of spinal infection in the context of previous EVAR, or indeed metallic spinal instrumentation that may preclude accurate assessment by MRI. This is supported by several studies that have shown 18 F-FDG PET/CT to be at least equivalent to MRI in diagnosing spondylodiscitis and may be used as a means of monitoring the response to treatment [33–37]. In the absence of PET/CT facilities, other nuclear medicine modalities including 99m Tc-MDP bone scan and Gallium scan (particularly when combined with single photon emission computed tomography (SPECT)/CT) have also been shown to be viable alternatives for the detection of spondylodiscitis [38, 39].…”

Spondylodiscitis: Diagnosis and Treatment Options

“…Fluorine-18 fluorodeoxyglucose positron emission tomography/CT ( 18 F-FDG-PET-CT) is a procedure well known in oncology and infectious diseases and appears to be playing an increasingly important role in the diagnosis of spondylodiscitis (18,19,34). PET-CT represents a good alternative particularly in the case of contraindications to contrast-enhanced MRI/CT (e.g., kidney failure).…”

Access, knowledge and experience with fluorodeoxyglucose positron emission tomography/computed tomography in infection management: a survey of Australia and New Zealand infectious diseases physicians and microbiologists

“…Fluorodeoxyglucose‐positron emission tomography combined with X‐ray computed tomography (FDG‐PET/CT) imaging has been used for many years as an effective method to stage and restage malignancies . Several studies have demonstrated high sensitivity of FDG‐PET/CT for diagnosis of infection of prosthetic devices, osteomyelitis and determining the aetiology of pyrexia of unknown origin (PUO) . Small studies have also demonstrated high clinical impact of FDG‐PET/CT in patients with neutropenic fever (NF) of unclear cause, with benefits of de‐escalating or rationalising antimicrobials, of directing further investigation such as bronchoscopy or tissue sampling and establishing an aetiological diagnosis of NF .…”

“…1 Several studies have demonstrated high sensitivity of FDG-PET/ CT for diagnosis of infection of prosthetic devices, osteomyelitis and determining the aetiology of pyrexia of unknown origin (PUO). [2][3][4] Small studies have also demonstrated high clinical impact of FDG-PET/CT in patients with neutropenic fever (NF) of unclear cause, with benefits of de-escalating or rationalising antimicrobials, of directing further investigation such as bronchoscopy or tissue sampling and establishing an aetiological diagnosis of NF. 5,6 There is emerging evidence that FDG-PET/CT is more sensitive for invasive fungal infection (IFI), its dissemination and response to therapy compared to traditional computed tomography (CT).…”