FDG PET Is a Robust Tool for the Diagnosis of Spondylodiscitis

Prodromou, Michael L.; Ziakas, Panayiotis D.; Poulou, Loukia S.; Karsaliakos, Petros; Thanos, Loukas; Mylonakis, Eleftherios

doi:10.1097/rlu.0000000000000336

Cited by 59 publications

(33 citation statements)

References 30 publications

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“…In a metaanalysis performed by Prodromou et al (14), diagnostic data on the use of 18 F-FDG PET for spondylodiskitis in 12 studies comprising 224 patients were evaluated. The combined sensitivity across these studies was 0.97, and the specificity was 0.88.…”

Section: Discussionmentioning

confidence: 99%

“…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: 99%

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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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“…Similarly, the negativity of CT scan emphasizes its lack of sensitivity at the early stages of spondylodiscitis, also demonstrated for MRI [38]. In this way, one can argue the usefulness of PET (positron emission tomography) CT scan in such presentation, because of its low likelihood ratio negative and performance at early stages of infection (even in the presence of spinal implant) [39].…”

Section: Surgical Managementmentioning

confidence: 95%

Surgical Management of L5-S1 Spondylodiscitis on Previously Documented Isthmic Spondylolisthesis: Case Report and Review of the Literature

Lubiato

Baucher

Meyer

et al. 2020

Case Reports in Surgery

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Background. Although lumbar isthmic spondylolisthesis is frequent in the Caucasian population, its association with spondylodiscitis is extremely rare. Case Description. The authors reported the case of a 44-year-old patient affected by pyogenic spondylodiscitis on previously documented isthmic spondylolisthesis at the L5-S1 level. The patient was surgically treated by circumferential arthrodesis combining anterior lumbar interbody fusion (ALIF), followed by L4-S1 percutaneous osteosynthesis using the same anesthesia. Appropriate antibiotherapy to methicillin-susceptible Staphylococcus aureus, found on the intraoperative samplings, was then delivered for 3 months, allowing satisfactory evolution on the clinical, biological, and radiological levels. Discussion. This is the first case report of spondylodiscitis affecting an isthmic spondylolisthesis surgically treated by circumferential arthrodesis. In addition to providing large samplings for analysis, it confirms the observed evolution over the past 30 years in modern care history of spondylodiscitis, increasingly including surgical treatment with spinal instrumentation, thus avoiding the need of an external immobilization. Care must nonetheless be exercised in performing the ALIF because of the inflammatory tissue increasing the risk of vascular injury. Conclusion. Spondylodiscitis occurring on an L5-S1 isthmic spondylolisthesis can be safely managed by circumferential arthrodesis combining ALIF then percutaneous osteosynthesis in the same anesthesia, obviously followed by appropriate antibiotherapy.

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“…In total, eight SR/MA were included for five indications [68][69][70][71][72][73][74][75]. All but two reviews [68,69] include a meta-analysis and consider diagnostic accuracy as the primary endpoint.…”

Section: Study Characteristicsmentioning

confidence: 99%

Evidence-based indications for the planning of PET or PET/CT capacities are needed

Fuchs¹,

Grössmann

Ferch³

et al. 2019

Clin Transl Imaging

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Purpose To identify evidence-based indications for PET/PET-CT scans in support of facilities planning and to describe a pilot project in which this information was applied for an investment decision in an Austrian region. The study updates a Health Technology Assessment (HTA) report (2015) on oncological indications, extending it to neurological indications and inflammatory disorders. Methods A systematic literature search to identify HTA reports, evidence-based guidelines, and systematic reviews/metaanalyses (SR/MA) was performed, supplemented by a manual search for professional society recommendations and explicit "not-to-do's". A needs-assessment was conducted in the context of the pilot study on investing in an additional PET-CT scanner in the Austrian region of Carinthia. Results Overall recommendations for indications as well as non-recommendations for the three areas (oncology, neurology, and inflammatory disorders) were compiled from the 2015 PET-HTA report and expanded for a final total of ten HTA, comprising 234 (positive and negative) recommendations from professional societies and databases, and supplemented by findings from 23 SR/MA. For the investment decision pilot study in Carinthia, 1762 PET scans were analyzed; 77.8% were assigned to the category "recommended evidence-based indications" (54.7%), "not recommended" (1.8%) or "contradictory recommendations" (21.3%). The remaining could not be assigned to any of the three categories. Conclusions The piloting of PET capacity planning using evidence-based information is a first of its kind in the published literature. On one hand, the high number of PET scans that could not be ascribed to any of the categories identified limits to the instructive power of the study to use evidence-based indication lists as the basis for a needs-assessment investment planning. On the other hand, this study reveals how there is a need to improve indication coding for enhanced capacity planning of medical services. Overall recommendations identified can serve as needs-based and evidence-based decision support for PET/PET-CT service provision.

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FDG PET Is a Robust Tool for the Diagnosis of Spondylodiscitis

Cited by 59 publications

References 30 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

Surgical Management of L5-S1 Spondylodiscitis on Previously Documented Isthmic Spondylolisthesis: Case Report and Review of the Literature

Evidence-based indications for the planning of PET or PET/CT capacities are needed

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FDG PET Is a Robust Tool for the Diagnosis of Spondylodiscitis

Cited by 59 publications

References 30 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

Surgical Management of L5-S1 Spondylodiscitis on Previously Documented Isthmic Spondylolisthesis: Case Report and Review of the Literature

Evidence-based indications for the planning of PET or PET/CT capacities are needed

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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