Positron emission tomography in spinal infections

Area of Science:

• Radiology
• Nuclear Medicine
• Orthopedics

Background:

• Spinal infections pose diagnostic challenges, particularly in patients with metallic implants or prosthetic replacements.
• Distinguishing between spinal infection and other conditions like Modic changes can be difficult with conventional imaging.
• Accurate assessment of infection activity and treatment response is crucial for effective patient management.

Purpose of the Study:

• To evaluate the role of magnetic resonance imaging (MRI) in diagnosing spinal infections.
• To assess the utility of 2-[(18)F]-fluoro-2deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) in specific diagnostic scenarios.
• To highlight the clinical impact and superiority of advanced imaging techniques in managing infectious spondylitis.

Main Methods:

• Review of magnetic resonance imaging (MRI) for diagnosing spinal infection in unoperated cases.
• Evaluation of 2-[(18)F]-fluoro-2deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) for differentiating spinal infection from Modic changes in patients with implants.
• Assessment of FDG-PET/CT for differentiating tuberculous from pyogenic spondylitis and for monitoring treatment response.

Main Results:

• MRI is the preferred imaging modality for diagnosing spinal infections in non-operative cases.
• FDG-PET/CT is recommended for distinguishing spinal infection from Modic changes in patients with metallic implants and for differentiating tuberculous from pyogenic spondylitis.
• FDG-PET/CT demonstrates significant clinical impact, superior ability to reveal residual disease, and early response to therapy compared to other techniques.

Conclusions:

• Advanced imaging techniques, particularly FDG-PET/CT, offer significant advantages in diagnosing and managing spinal infections.
• FDG-PET/CT plays a vital role in complex cases involving implants and differentiating infectious etiologies.
• Ongoing research into new tracers and hybrid modalities promises further advancements in imaging spinal infections.