Higher fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) uptake in tuberculous compared to bacterial spondylodiscitis

Bassetti, Matteo; Merelli, Maria; Gregorio, Fernando Di; Siega, Paola Della; Screm, Maria; Scarparo, Claudio; Righi, Elda

doi:10.1007/s00256-017-2615-8

Cited by 25 publications

(19 citation statements)

References 8 publications

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“…In this setting, imaging represents a key diagnostic tool to achieve early diagnosis of the disease and to monitor the response to antibiotic treatment. As observed previously (Bassetti et al, 2017), the association of specific FDG-PET/CT features, such as high SUV, with tubercular VO has been reported but remains to be determined definitively (Bakheet et al, 1998;Trecarichi et al, 2012). Then, the confirmation of high SUV values could allow physicians to consider a tubercular etiology for VO in a more timely manner (Heysell et al, 2013).…”

Section: Discussionmentioning

confidence: 79%

“…In this study population, failure of therapy for VO was observed in 19 patients (14.3%). The failure rate of patients treated for VO in most clinical studies has varied between 10% and 30% (Berbari et al, 2015;Ohtori et al, 2010;Hungenbach et al, 2013;Sehn and Gilula, 2012;Bhavan et al, 2010;Saeed et al, 2019;Kowalski et al, 2007;Zarrouk et al, 2007;Carragee, 1997;Nanni et al, 2012;Kim et al, 2009;Bassetti et al, 2017;Bakheet et al, 1998;Trecarichi et al, 2012;Heysell et al, 2013;Rissing, 1997). The therapeutic management of VO patients with treatment failure should be tailored to the suspected reason for failure.…”

Section: Discussionmentioning

confidence: 99%

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Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis)

Russo

Graziano

Carnelutti

et al. 2019

International Journal of Infectious Diseases

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Objectives: Vertebral osteomyelitis (VO) is a compelling clinical entity for clinicians because of its insidious and indolent course, which makes diagnosis difficult. Methods: All patients with a suspected diagnosis of VO were analyzed over an 8-year period (January 2009 to January 2017). The UDIPROVE protocol (UDIne PROtocol on VErtebral osteomyelitis) was applied in all cases. The primary endpoint was the performance of the UDIPROVE protocol to obtain the causal bacteria of infection. Results: During the study period, 133 episodes of confirmed VO were observed. The etiology of infection was obtained in 73.6% of cases: 70.5% were gram-positive, 16.3% were gram-negative, and 13.2% were mycobacteria. 18 F-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/ CT) showed that for tubercular VO, the median standard uptake value (SUV) was higher when compared with VO caused by other bacteria. Clinical cure at the end of therapy was reported in 85.7% of patients. Previous antimicrobial therapy and a delay of more than 5 days in performing biopsy were associated with an undiagnosed etiology of VO. Targeted antibacterial therapy and follow-up with FDG-PET/CT were associated with clinical cure at the end of therapy, while the involvement of more than two vertebrae and inadequate drainage were associated with failure. Conclusions: Rigorous application of the UDIPROVE protocol allowed the causative pathogens of VO to be obtainedat about twice the rate reported in the literature. The use of FDG-PET/CT for the follow-up of infection was more reliable when compared to magnetic resonance imaging (MRI).

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis)

Russo

Graziano

Carnelutti

et al. 2019

International Journal of Infectious Diseases

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“…involved, with some data showing different uptake values according with the etiology of infection [13]. Specifically, higher uptake values have been reported in tuberculous spondylodiscitis compared with pyogenic one [17].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…In mycobacterial vertebral osteomyelitis higher uptakes levels at FDG-PET were detected in in comparison with pyogenic spondylodiscitis. PET-CT use appeared useful in the disease follow-up after treatment initiation to guide duration [17].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

Saeed

Esposito

Ascione³

et al. 2019

International Journal of Antimicrobial Agents

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Vertebral osteomyelitis (VO), also known as spondylodiscitis, describes infections of the vertebrae and intervertebral discs. Discitis describes infection limited to the intervertebral discs; in clinical practice both discitis and VO can be regarded as different stages of a single entity. VO can be caused by bacteria, fungi and parasites The incidence of VO is increasing globally representing 3-5% of all osteomyelitis with an estimated incidence ranging from 4 to 24 per million per year. Increasing incidence has been attributed to a combination of improved diagnostics, increased healthcare associated infections, haemodialysis, indwelling catheters, intravenous drug use, spinal instrumentation, immunocompromised hosts and an ageing population [1]. If left untreated, VO can lead to irreversible spinal cord injury, deformity, neurologic deficits, septicaemia, and mortality (mortality rates ranges 4%-29%). VO is typically treated with antibiotics, but up to 40% to 50% of VO patients may eventually require surgical intervention [1-3] Despite advances in diagnostic modalities, medical and surgical care, there are still many controversial areas with regards to both diagnostic and therapeutic strategies in VO. In this review a number of 'hot topics' on VO were selected and reviewed by members of the Skin, Soft Tissue and Bone Infections Working Group of the International Society of Antimicrobial Chemotherapy (ISAC). This group includes international scientists, microbiology and infectious diseases clinicians and academics, whose aim is to advance the education and the science of infection management. This paper is an in-depth review of the current literature, providing a summary of the various aspects of VO and expert opinions and insights from the authors' own experience, highlighting areas for future study and research.

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“…Imaging-guide vertebral biopsy is a gold standard for differentiating tubercular and pyogenic spondylodiscitis. MRI and 18 F-FDG PET/CT were helpful for evaluating the extension of the infection [35]. The main MRI findings, suggestive for tubercular spondylodiscitis, indicated sparing of the intervertebral disc in the early stages of infection, loss of vertebral body cortical definition, multiple vertebral involvement, and the presence of muscular (paraspinal, psoas) abscesses [34,35].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Diagnostic Value of MRI and Whole Body 18F-FDG PET/CT in Diagnosis of Spondylodiscitis

Altini

Lavelli

Asabella

et al. 2020

JCM

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Spondylodiscitis is a spine infection for which a diagnosis by a magnetic resonance imaging (MRI) is considered the most appropriate imaging technique. The aim of this study was to compare the role of an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and an MRI in this field. For 56 patients with suspected spondylodiscitis for whom MRI and 18F-FDG PET/CT were performed, we retrospectively analyzed the results. Cohen’s κ was applied to evaluate the agreement between the two techniques in all patients and in subgroups with a different number of spinal districts analyzed by the MRI. Sensitivity, specificity, and accuracy were also evaluated. The agreements of the 18F-FDG PET/CT and MRI in the evaluation of the entire population, whole-spine MRI, and two-districts MRI were moderate (κ = 0.456, κ = 0.432, and κ = 0.429, respectively). In patients for whom one-district MRI was performed, 18F-FDG PET/CT and MRI were both positive and completely concordant (κ = 1). We also separately evaluated patients with suspected spondylodiscitis caused by Mycobacterium tuberculosis for whom the MRI and 18F-FDG PET/CT were always concordant excepting in 2 of the 18 (11%) patients. Sensitivity, specificity, and accuracy of the MRI and 18F-FDG PET/CT were 100%, 60%, 97%, and 92%, 100%, and 94%, respectively. Our results confirmed the 18F-FDG PET/CT diagnostic value in the diagnosis of spondylodiscitis is comparable to that of MRI for the entire spine evaluation. This could be considered a complementary technique or a valid alternative to MRI.

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Higher fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) uptake in tuberculous compared to bacterial spondylodiscitis

Abstract: Higher SUV levels at FDG-PET were detected in tuberculous compared with pyogenic spondylodiscitis. PET-CT use appeared useful in the disease follow-up after treatment initiation.

Cited by 25 publications

References 8 publications

Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis)

Management of vertebral osteomyelitis over an eight-year period: The UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis)

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

Comparison of the Diagnostic Value of MRI and Whole Body 18F-FDG PET/CT in Diagnosis of Spondylodiscitis

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