Assessment of Therapeutic Response in Pyogenic Vertebral Osteomyelitis Using ¹⁸F-FDG-PET/MRI

Area of Science:

• Nuclear Medicine
• Radiology
• Infectious Diseases

Background:

• Pyogenic vertebral osteomyelitis (PVO) lacks definitive methods for assessing treatment response.
• Early and accurate evaluation of therapeutic effectiveness is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in assessing therapeutic response in patients with PVO.
• To compare the accuracy of FDG-PET findings with C-reactive protein (CRP) levels in detecting residual PVO.

Main Methods:

• Retrospective analysis of 53 patients with lumbar PVO.
• Clinical assessments and simultaneous FDG-PET/MRI were performed during antibiotic therapy.
• Patients were categorized into 'Cured' and 'Non-cured' groups based on clinical response.

Main Results:

• FDG-PET intensity-based interpretation showed high diagnostic accuracies (84.9-86.8%) for residual PVO.
• Combining FDG-PET intensity interpretation with CRP levels further improved diagnostic accuracy (92.5-94.3%).
• FDG uptake distribution limited to intervertebral structures was significantly associated with a 'Cured' status (p=0.026).

Conclusions:

• FDG-PET, assessing both intensity and distribution of uptake, is valuable for detecting residual PVO.
• The combination of FDG-PET and CRP enhances the diagnostic accuracy for residual PVO.
• FDG-PET offers a promising tool for monitoring therapeutic response in PVO.