Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-05-2018 | Original Article

The diagnostic value of ¹⁸F–FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study

Authors: Ilse J. E. Kouijzer, Henk Scheper, Jacky W. J. de Rooy, Johan L. Bloem, Marcel J. R. Janssen, Leon van den Hoven, Allard J. F. Hosman, Leo G. Visser, Wim J. G. Oyen, Chantal P. Bleeker-Rovers, Lioe-Fee de Geus-Oei

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 5/2018

Abstract

Purpose

The aim of this study was to determine the diagnostic value of ¹⁸F–fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis.

Methods

From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both ¹⁸F–FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others’ image interpretation. ¹⁸F–FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines.

Results

For ¹⁸F–FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of ¹⁸F–FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%).

Conclusion

¹⁸F–FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of ¹⁸F–FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65:11–24.CrossRef

Solis Garcia del Pozo J, Vives Soto M, Solera J. Vertebral osteomyelitis: long-term disability assessment and prognostic factors. J Inf Secur. 2007;54:129–34.

McHenry M, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis. 2002;34:1342–50.CrossRefPubMed

Gupta A, Kowalski TJ, Osmon DR, Enzler M, Steckelberg JM, Huddleston PM, et al. Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients. Open Forum Infect Dis. 2014;1:ofu107.CrossRefPubMedPubMedCentral

Kouijzer IJE, Vos F, Bleeker-Rovers CP, Oyen WJG. Clinical application of FDG-PET/CT in metastatic infections. Q J Nucl Med Mol Imaging. 2017;61:232–46.PubMed

Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA. MR imaging findings in spinal infections: rules or myths? Radiology. 2003;228:506–14.CrossRefPubMed

Sans N, Faruch M, Lapegue F, Ponsot A, Chiavassa H, Railhac JJ. Infections of the spinal column - spondylodiscitis. Diagn Interv Imaging. 2012;93:520–9.CrossRefPubMed

Dunbar JA, Sandoe JA, Rao AS, Crimmins DW, Baig W, Rankine JJ. The MRI appearances of early vertebral osteomyelitis and discitis. Clin Radiol. 2010;65:974–81.CrossRefPubMed

Carragee EJ. The clinical use of magnetic resonance imaging in pyogenic vertebral osteomyelitis. Spine. 1997;22:780–5.CrossRefPubMed

10.

Gratz S, Dorner J, Fischer U, Behr TM, Behe M, Altenvoerde G, et al. 18F-FDG hybrid PET in patients with suspected spondylitis. Eur J Nucl Med Mol Imaging. 2002;29:516–24.CrossRefPubMed

11.

Stumpe KD, Zanetti M, Weishaupt D, Hodler J, Boos N, Von Schulthess GK. FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol. 2002;179:1151–7.CrossRefPubMed

12.

Schmitz A, Risse JH, Grunwald F, Gassel F, Biersack HJ, Schmitt O. Fluorine-18 fluorodeoxyglucose positron emission tomography findings in spondylodiscitis: preliminary results. Eur Spine J. 2001;10:534–9.CrossRefPubMedPubMedCentral

13.

Fuster D, Sola O, Soriano A, Monegal A, Setoain X, Tomas X, et al. A prospective study comparing whole-body FDG PET/CT to combined planar bone scan with 67Ga SPECT/CT in the diagnosis of spondylodiskitis. Clin Nucl Med. 2012;37:827–32.CrossRefPubMed

14.

Fuster D, Tomas X, Mayoral M, Soriano A, Manchon F, Cardenal C, et al. Prospective comparison of whole-body 18F-FDG-PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging. 2015;42:264–71.CrossRefPubMed

15.

Seifen T, Rettenbacher L, Thaler C, Holzmannhofer J, Mc Coy M, Pirich C. Prolonged back pain attributed to suspected spondylodiscitis. The value of (18)F-FDG PET/CT imaging in the diagnostic work-up of patients. Nuklearmedizin. 2012;51:194–200.CrossRefPubMed

16.

Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral Osteomyelitis in adults. Clin Infect Dis. 2015;61:e26–46.CrossRefPubMed

17.

Smids C, Kouijzer IJE, Vos FJ, Sprong T, Hosman AJR, de Rooy JWJ, et al. A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis. Infection. 2017;45:41–9.CrossRefPubMed

18.

Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS. MR imaging assessment of the spine: infection or an imitation? Radiographics. 2009;29:599–612.CrossRefPubMed

19.

Vos FJ, Bleeker-Rovers CP, Sturm PD, Krabbe PF, van Dijk AP, Cuijpers ML, et al. 18F-FDG PET/CT for detection of metastatic infection in gram-positive bacteremia. J Nucl Med. 2010;51:1234–40.CrossRefPubMed

20.

Kestler M, Munoz P, Rodriguez-Creixems M, Rotger A, Jimenez-Requena F, Mari A, et al. Role of (18)F-FDG PET in patients with infectious Endocarditis. J Nucl Med. 2014;55:1093–8.CrossRefPubMed

21.

Fahnert J, Purz S, Jarvers JS, Heyde CE, Barthel H, Stumpp P, et al. Use of simultaneous 18F-FDG PET/MRI for the detection of Spondylodiskitis. J Nucl Med. 2016;57:1396–401.CrossRefPubMed

Title: The diagnostic value of 18F–FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study
Authors: Ilse J. E. Kouijzer
Henk Scheper
Jacky W. J. de Rooy
Johan L. Bloem
Marcel J. R. Janssen
Leon van den Hoven
Allard J. F. Hosman
Leo G. Visser
Wim J. G. Oyen
Chantal P. Bleeker-Rovers
Lioe-Fee de Geus-Oei
Publication date: 01-05-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 5/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-017-3912-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The diagnostic value of ¹⁸F–FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2018

Preoperative prediction of microvascular invasion of hepatocellular carcinoma using 18F-FDG PET/CT: a multicenter retrospective cohort study

H. William Strauss, Giuliano Mariani, Duccio Volterrani, Steven M. Larson (editors): Nuclear Oncology: From Pathophysiology to Clinical Applications, second edition

Liver metastases from prostate cancer at 11C-Choline PET/CT: a multicenter, retrospective analysis

Interim FDG PET/CT in primary mediastinal diffuse large B-cell lymphoma: really almost useless procedure?

Value of 18F–FDG PET/CT for predicting EGFR mutations and positive ALK expression in patients with non-small cell lung cancer: a retrospective analysis of 849 Chinese patients

Superiority of 68Ga-DOTATATE over 18F-FDG and anatomic imaging in the detection of succinate dehydrogenase mutation (SDHx )-related pheochromocytoma and paraganglioma in the pediatric population