Prediction of residual disease of spine infection using F-18 FDG PET/CT.
METHODS
Prospective study.


OBJECTIVE
To determine whether F-18 fluoro-deoxy-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT) follow-up imaging after treatment in patients with spinal infection (SI) could provide useful prognostic information and determine the residual SI.


BACKGROUND
There are seldom data on the capability of follow-up imaging methods to predict residual disease and treatment efficacy in patients with SI.


METHODS
Thirty patients with SI underwent F-18 FDG PET/CT at initial and during follow-up. From F-18 FDG PET/CT, quantitative indexes were obtained. The residual SI was determined by the presence of preoperative symptoms, hematological infection marker, and radiologic findings.


RESULTS
The SUVmax were significantly declined after treatment in both of residual (2.85 +/- 1.17 vs. 2.06 +/- 1.03; P < 0.0001) and nonresidual SI (4.31 +/- 2.07 vs. 1.44 +/- 0.46; P < 0.0001). The SUVmean were also decreased after treatment in both of residual (1.45 +/- 0.45 vs. 1.04 +/- 0.29; P = 0.0014) and nonresidual SI (2.09 +/- 1.03 vs. 0.81 +/- 0.25; P < 0.0001). By lesion-based analysis, when < or =43.01% of %deltaSUVmax was used as threshold value, the area under curve (AUC) was 0.879 (P = 0.0001). The sensitivity and specificity were 85.7% and 82.6%, respectively. When < or =44.12% of %deltaSUVmean was used as threshold value, AUC was 0.828 (P = 0.0001). The sensitivity and specificity were 85.7% and 68%, respectively. In patient-based analysis, when < or =46.14% of %deltaSUVmax was used as threshold value, AUC was 0.904 (P = 0.0001). The sensitivity and specificity were 100% and 76.9%, respectively. When < or =41.78% of %deltaSUVmean was used as threshold value, AUC was 0.923 (P = 0.0001). The sensitivity and specificity were 100%, 76.9%, respectively.


CONCLUSIONS
F-18 FDG PET/CT is useful for discrimination of residual and nonresidual SI after treatment. Among the various quantitative indexes, %deltaSUVmax is a potent predictor of residual SI in the current study.
Kim
Seong-Jang
SJ
Department of Nuclear Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
Kim
In-Ju
IJ
Suh
Kuen Tak
KT
Kim
Yong-Ki
YK
Lee
Jung Sub
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000382:microbiology; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005334:Fever / Q000209:etiology; D019788:Fluorodeoxyglucose F18; D020233:Gait Disorders, Neurologic / Q000382:microbiology; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000382:microbiology; D013122:Spinal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult
D019788:Fluorodeoxyglucose F18