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Nuklearmedizin 2012; 51(05): 194-200
DOI: 10.3413/Nukmed-0473-12-01
Original article
Schattauer GmbH

Prolonged back pain attributed to suspected spondylodiscitis

The value of 18F-FDG PET/CT imaging in the diagnostic work-up of patientsRückenschmerzen mit Verdacht auf Spondylo-diszitisDie diagnostische Bedeutung der 18F-FDG-PET/CT-Bildgebung
T. Seifen
1   Department of Nuclear Medicine and Endocrinology, University Hospital of Salzburg, Austria
,
L. Rettenbacher
1   Department of Nuclear Medicine and Endocrinology, University Hospital of Salzburg, Austria
,
C. Thaler
2   Department of Orthopaedics, University Hospital of Salzburg, Austria;
,
J. Holzmannhofer
1   Department of Nuclear Medicine and Endocrinology, University Hospital of Salzburg, Austria
,
M. Mc Coy
3   Department of Radiology, Christian-Doppler-Clinic, University Hospital of Salzburg, Austria
,
C. Pirich
1   Department of Nuclear Medicine and Endocrinology, University Hospital of Salzburg, Austria
› Author Affiliations
Further Information

Publication History

received: 28 January 2012

accepted in revised form: 08 May 2012

Publication Date:
02 January 2018 (online)

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Summary

Objective: This study aimed at investigating the diagnostic value of 18F-FDG PET/CT in cases of suspected spondylodiscitis after inconclusive results in initial diagnostic imaging. Patients, methods: We analysed 38 consecutive cases of suspected spondylodiscitis (mean age: 67 ± 14 years) with chronic back pain referred to our Department during a fouryear- period after inconclusive results in MRI or other conventional modalities. Clinical histories were retrospectively worked up and results of 18F-FDG PET/CT and MRI were analysed and related to the results of biopsy, blood culture and a one-year clinical followup. 18F-FDG PET/CT was analysed qualitatively by visual analysis and quantitatively. We measured the maximum standardized uptake value (SUVmax) in the region of back pain and in a corresponding reference region (RR) in each patient and calculated a SUVmax-ratio. Results: 22/38 patients had confirmed spondylodiscitis, while 16 were negative. 18F-FDG PET/CT established a correct diagnosis in 34 out of 38 patients by visual analysis. 18F-FDG PET/CT reached a sensitivity, specificity and accuracy of 81.8%, 100%, 89.5% and a PPV and NPV of 100% and 80%. MRI, performed in 27 patients reached a sensitivity, specificity and accuracy of 75%, 71.4%, 74.1% and a PPV and NPV of 88.2% and 50%. Patients with confirmed spondylodiscitis showed a significantly (p < 0.05) higher SUVmax of 5.1 ± 1.9 and SUVmax-ratio of 1.9 ± 0.8 than patients without it (SUVmax (3.8 ± 1.5), SUVmaxratio (1.2 ± 0.3). Conclusion: 18F-FDG PET/CT provided diagnostic information in most patients with chronic back pain and suspected spondylodiscitis. It was helpful in establishing a correct diagnosis in challenging cases of spondylodiscitis with mostly unclear findings in previous MRI.

Zusammenfassung

Das Ziel dieser Studie war die Beurteilung des diagnostischen Wertes der 18F-FDG-PET/CT nach nicht eindeutig beurteilbaren Ergebnissen in der Standard-Bildgebung und Verdacht aufSpondylodiszitis. Patienten, Methode: 38 Patienten (mittleres Alter: 67 ± 14 Jahre) wurden innerhalb von vier Jahren nach unklaren MRI- und anderen Bildgebungsbefunden an unserer Abteilung retrospektiv analysiert. Die Ergebnisse von 18F-FDG PET/CT und MRI wurden mit den Resultaten von Biopsie, Blutkultur und der 1-Jahres-Verlaufskontrolle verglichen. Neben visuell-qualitativer erfolgte eine quantitative Analyse der 18F-FDG-PET/CT mit einer Messung der maximalen standardisierten Aufnahmewerte (SUVmax) in der betroffenen Region sowie in einer definierten Referenzregion (RR) und eine Bestimmung des SUVmax-Quotienten. Ergebnisse: Der Verdacht auf Spondylodiszitis bestätigte sich in 22/38 Fällen, in 16 erfolgte ein Ausschluss. Die 18F-FDG-PET/CT war in 34/38 Fällen diagnostisch korrekt. Es wurden 18 richtig positiv, 16 richtig negativ, 4 falsch negativ und keiner falsch positiv beurteilt. Die 18F-FDG PET/CT erzielte eine Sensitivität, Spezifität und Genauigkeit von je 81,8%, 100%, 89,5% und einen positiven (PPV) und negativen prädiktiven Vorhersagewert (NPV) von 100% und 80%. Die MRI (27 Patienten) erzielte eine Sensitivität, Spezifität und Genauigkeit von 75%, 71,4%, 74,1% und einen PPV und NPV von 88,2% und 50%. Patienten mit bestätigter Spondylodiszitis zeigten signifikant höhere SUVmax (5,1 ± 1,9) und SUVmax-Quotienten (1,9 ± 0,8) als jene mit nicht bestätigter Spondylodiszitis (3,8 ± 1,5) und (1,2 ± 0,3) (p < 0,05). Schlussfolgerung: Die 18F-FDG-PET/CT liefert korrekte Ergebnisse bei den meisten Patienten mit chronischen Rückenschmerzen und Verdachtsdiagnose Spondylodiszitis. Sie erwies sich besonders in der Diagnosefindung von Fällen mit inkonklusivem MRI als hilfreich.

Keywords

Spondylodiscitis - 18F-FDG PET/CT - inflammation - MRI - chronic course

Schlüsselwörter

Spondylodiszitis - 18F-FDG PET/CT - Entzündung - MRI - chronischer Verlauf
 

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