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Skeletal Radiology
Published in: Skeletal Radiology 6/2020

01-06-2020 | Magnetic Resonance Imaging | Scientific Article

Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis

Authors: Elda Righi, Alessia Carnelutti, Daniele Muser, Fernando Di Gregorio, Barbara Cadeo, Giulia Melchioretto, Maria Merelli, Abass Alavi, Matteo Bassetti

Published in: Skeletal Radiology | Issue 6/2020

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Abstract

Objective

To assess the added value of serial 2-deoxy-2-[18F]fluoro-D-glucose (FDG) uptake analysis in predicting clinical response to treatment in infectious spondylodiscitis (IS). We sought to analyze changes in quantitative FDG-PET/CT parameters among patients with clinical response or treatment failure and to compare the sensitivity and specificity of serial FDG-PET/CT and MRI in predicting treatment response in IS.

Materials and methods

This retrospective study consisted of 68 FDG-PET/CT examinations in 34 patients performed before and after at least 2 weeks of antibiotic treatment. Serial MRI scans were available in 32 (94%) patients before and after treatment. FDG-avid lesions were quantified as maximum standardized uptake value (SUVmax), partial-volume corrected lesion metabolic volume (LMV), and partial-volume corrected lesion metabolic activity (LMA).

Results

All FDG-PET/CT parameters significantly decreased in patients with clinical improvement (31/34, 91%, P < 0.001), while patients with disease progression did not show FDG-PET/CT improvement. FDG uptake decrease was similar between patients undergoing early assessment (< 6 weeks) compared with those performing FDG-PET/CT after 6 weeks of treatment. SUVmax, LMV, and LMA decrease over time was 39.0%, 97.4%, and 97.1%, respectively. In predicting clinical responses, SUVmax reduction > 15% and > 25% showed 94% and 89% sensitivity and 67% and 100% specificity compared with 37% and 50% of MRI, respectively. Low degree of agreement with clinical response was shown for MRI compared with FDG-PET/CT parameters using the Cohen kappa coefficient.

Conclusions

FDG-PET/CT monitoring is a valuable tool to predict clinical response to treatment in IS and has greater sensitivity and specificity compared with MRI.
Appendix
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Metadata
Title
Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis
Authors
Elda Righi
Alessia Carnelutti
Daniele Muser
Fernando Di Gregorio
Barbara Cadeo
Giulia Melchioretto
Maria Merelli
Abass Alavi
Matteo Bassetti
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 6/2020
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-019-03328-4

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