Simultaneous 18F-FDG PET/MRI in tuberculous spondylitis: an independent method for assessing therapeutic response - case series

Abstract

Background 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) shows great potential for diagnosis and assessing therapeutic response of tuberculous spondylitis. Tuberculous spondylitis required long-term anti-tuberculosis (TB) medication therapy, and the optimal duration of therapy is controversial. There is still no clear way to tell when the anti-TB therapy can safely be discontinued. Case presentation Three patients with tuberculous spondylitis were evaluated for therapeutic response using 18F-FDG PET/magnetic resonance imaging (MRI). Clinical and hematological improvements were achieved after about 12 months of anti-TB medication therapy, and we considered whether to discontinue the therapy. There was no relapse during one year of follow-up after discontinuation of 12 months anti-TB medication based on the low maximum standardized uptake value (SUVmax) of 1.83 in one patient. However, the other two patients continued further anti-TB medication therapy based on the high SUVmax of 4.14 and 7.02, which were suspected to indicate active residual lesions in the abscess or granulation tissues. Continuous TB was confirmed by the bacterial and histological examinations. Conclusions 18F-FDG PET/MRI has metabolic and anatomical advantages for assessing therapeutic response in TB spondylitis, and can be considered as a helpful independent and alternative method for determining the appropriate time to discontinue anti-TB medication.

Clinical and Radiological Analysis of Pyogenic Vertebral Osteomyelitis Immediately after Successful Antimicrobial Therapy: Considerations for Assessing Therapeutic Response

“…In particular, 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) was used to analyze the metabolic characteristics of cured PVO lesion, and the results were compared with the clinical features and MRI findings. Recently, studies related to the use of FDG-PET to assess therapeutic response in spine infection have been reported; this approach can be less affected by the other conditions than hematological inflammatory indices [ 9 , 10 , 11 ]. Although FDG-PET has merit in identifying metabolic changes in infectious conditions, it has limited ability to visualize anatomical changes.…”

18F-fluorodeoxyglucose positron emission tomography/computed tomography as a metabolic marker for functional assessment of spinal tuberculosis after early decompression surgery

“…Excellent spatial resolution combined with metabolic evolution and reduced overall patient radiation dose is a few of the important advantages in comparison to PET/CT. [ 11 ] Cost is the only limiting factor.…”

Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET

“…In the assessment of therapeutic response in spine infection, the attempts to apply 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET) have been going on for 10 years, and detailed research results have been reported [ 10 , 11 ]. 18 F-FDG-PET is considered to be less affected by other conditions than blood inflammatory markers [ 12 ].…”