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18F-FDG-PET/CT better localizes active spinal infection than MRI for successful minimally invasive surgery
Masayuki Nakahara1, Manabu Ito2, Naoya Hattori3
1Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Background:
Surgical debridement is often required to treat spinal infections. Successful surgery requires accurate localization of the active infections, however, current imaging technique still requires surgeons' experience to narrow the surgical fields to achieve less invasive procedures.
Purpose:
To investigate the use of F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for successful surgical planning.
Material And Methods:
Nine patients with suspected spinal infection underwent magnetic resonance imaging (MRI) and FDG-PET/CT before surgery to locate active foci of infections. The spinal structures were divided into seven compartments at each intervertebral disc level for a total of 315 compartments investigated. The same classification system was used to design operating fields for histological correlation.
Results:
FDG-PET/CT diagnosed fewer compartments as active infection (34 compartments, 10.8%) than MRI (62 compartments, 19.7%, P = 0.002). Surgical exploration was performed in 49 compartments, and demonstrated active infection in 25 compartments. The sensitivity / specificity of FDG-PET/CT was 100% / 79%, respectively, which was superior to those of MRI, 76% / 42%. Foci of active infection showed hypermetabolic activity with a SUVmax of 7.1 ± 2.6 (range, 3.0-12.7). Receiver operating characteristic (ROC) analysis indicated an optimal threshold for active spinal infection at a SUVmax of 4.2, corresponding to a sensitivity of 90.3% and specificity of 91.2%.
Conclusion:
FDG-PET/CT demonstrated limited areas of abnormality allowing accurate delineation, and is thus useful to narrow the surgical fields. Since overall diagnostic accuracy of FDG-PET/CT was superior to that of MRI, FDG-PET/CT is a useful technique to narrow the surgical field for successful less invasive surgery.
Insights
F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) accurately identifies spinal infection foci, enabling surgeons to narrow surgical fields for less invasive procedures. This imaging technique offers superior diagnostic accuracy compared to MRI for spinal infection.
Area of Science:
- Nuclear medicine and radiology
- Spinal surgery and infection management
Background:
- Surgical debridement is crucial for treating spinal infections, but precise localization of active infection is challenging with current imaging.
- Accurate localization is essential for less invasive surgical procedures, often relying on surgeon experience to define surgical fields.
Purpose of the Study:
- To evaluate the utility of F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in planning successful spinal surgery.
- To determine if FDG-PET/CT can improve the accuracy of identifying active infection sites in the spine.
Main Methods:
- Nine patients with suspected spinal infections underwent both MRI and FDG-PET/CT for pre-operative localization of infection foci.
- Spinal structures were systematically divided into compartments for detailed analysis and correlation with surgical findings.
- A classification system was used to define operating fields for histological examination and comparison.
Main Results:
- FDG-PET/CT identified significantly fewer infected compartments (10.8%) compared to MRI (19.7%, P=0.002).
- FDG-PET/CT demonstrated superior sensitivity (100%) and specificity (79%) compared to MRI (76% / 42%) in diagnosing active infection.
- Receiver operating characteristic analysis identified an optimal SUVmax threshold of 4.2 for active spinal infection, yielding 90.3% sensitivity and 91.2% specificity.
Conclusions:
- FDG-PET/CT effectively delineates limited areas of abnormality, proving useful for narrowing surgical fields in spinal infections.
- The superior diagnostic accuracy of FDG-PET/CT over MRI supports its role in guiding less invasive surgical interventions.
- FDG-PET/CT facilitates successful, less invasive surgery by accurately identifying the extent of spinal infection.
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