Incremental Value of FDG-PET/CT to Monitor Treatment Response in Infectious Spondylodiscitis

Overview

Journal Skeletal Radiol

Specialties Orthopedics
Radiology

Date 2020 Jan 5

PMID 31900514

Citations 7

Authors

Elda Righi

Alessia Carnelutti

Daniele Muser

Fernando Di Gregorio

Barbara Cadeo

Giulia Melchioretto

Maria Merelli

Abass Alavi

Matteo Bassetti

Affiliations

Soon will be listed here.

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 (SUV), 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. SUV, LMV, and LMA decrease over time was 39.0%, 97.4%, and 97.1%, respectively. In predicting clinical responses, SUV 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.

Citing Articles

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Application of Nuclear Medicine Techniques in Musculoskeletal Infection: Current Trends and Future Prospects.

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Spine Infections: The Role of Fluorodeoxyglucose Positron Emission Tomography (FDG PET) in the Context of the Actual Diagnosis Guideline.

Boriani L, Zamparini E, Albrizio M, Serani F, Ciani G, Marconi L Curr Med Imaging. 2021; 18(2):216-230.

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F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization.

Ten Hove D, Slart R, Sinha B, Glaudemans A, Budde R Curr Cardiol Rep. 2021; 23(9):130.

PMID: 34363148 PMC: 8346431. DOI: 10.1007/s11886-021-01542-y.

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