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Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain
Published on: August 8, 2019
The routine clinical use of fluorodeoxyglucose PET/CT to confirm treatment response in pyogenic spine infection
Hans W Lafford1,2, Errol E Stewart3, Ingrid L Koslowsky3
1Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada. hans.lafford@albertahealthservices.ca.
Objective:
Response of pyogenic spine infection to antibiotic therapy is usually based on nonspecific symptoms and inflammation markers. Abnormalities on MRI persist too long to influence therapy. Is FDG-PET/CT a timely and robust predictor of successful therapy?
Materials And Methods:
Retrospective study. Sequential FDG-PET/CTs done to assess treatment response over a 4-year period. Recurrence of infection after stopping treatment was the endpoint.
Results:
One hundred seven patients enrolled. First treatment response scan showed no signs of infection in 69 patients (low risk). Twenty-four additional patients underwent additional treatment after an initial positive scan with low-risk pattern on follow-up imaging. After stopping antibiotics, none had clinical recurrence of infection. One had positive cultures at surgery for negative predictive value of 0.99. Thirty-eight patients had evidence of residual infection. Abnormalities in 28 were comparable to what is seen with untreated infection (high-risk). Twenty-seven received additional treatment until resolution. Antibiotics were stopped in 1 who suffered recurrence. Ten had low-grade/localized abnormalities consistent with infection (intermediate-risk). Signs of infection resolved in 3 after additional treatment. Of the remaining 7 patients who had minor residual abnormalities when antibiotics were stopped, 1 had recurrent infection for a positive predictive value of 0.14.
Conclusion:
Risk stratification proposed: A low-risk scan with only inflammation at a destroyed joint indicates negligible risk of recurrence. Unexplained activity in bone, soft tissue or spinal canal indicates high risk with further antibiotics recommended. Most patients with subtle or localized findings (intermediate risk) did not experience recurrence. Stopping therapy could be considered under careful observation.
Insights
Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) effectively predicts pyogenic spine infection treatment success. Low-risk FDG-PET/CT scans indicate negligible recurrence risk, guiding antibiotic therapy decisions.
Area of Science:
- Nuclear Medicine
- Infectious Diseases
- Orthopedic Surgery
Background:
- Pyogenic spine infection treatment response is typically assessed using nonspecific symptoms and inflammation markers.
- Magnetic resonance imaging (MRI) abnormalities persist, limiting its utility in guiding therapy adjustments.
- A need exists for a timely and robust predictor of successful antibiotic therapy for spinal infections.
Purpose of the Study:
- To evaluate the efficacy of sequential Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans in predicting treatment response for pyogenic spine infections.
- To determine if FDG-PET/CT can serve as a timely and reliable indicator of successful antibiotic therapy.
Main Methods:
- Retrospective analysis of 107 patients undergoing sequential FDG-PET/CT scans over a 4-year period.
- Infection recurrence after antibiotic cessation was the primary endpoint.
- Patients were categorized into low, intermediate, and high-risk groups based on FDG-PET/CT findings.
Main Results:
- A negative predictive value of 0.99 was observed for low-risk FDG-PET/CT scans, with no clinical recurrence in patients initially showing no infection signs.
- High-risk FDG-PET/CT findings correlated with residual infection, necessitating further antibiotic treatment.
- Intermediate-risk findings showed a low recurrence rate (1/7), suggesting potential for therapy cessation under observation.
Conclusions:
- FDG-PET/CT provides effective risk stratification for pyogenic spine infections, distinguishing patients with negligible recurrence risk from those requiring further treatment.
- Low-risk scans indicate successful therapy, while unexplained activity suggests high risk and continued antibiotics.
- Intermediate-risk findings suggest that antibiotic therapy could be stopped with careful monitoring.
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