title: 18F-FDG-PET/CT better localizes active spinal infection than MRI for successful minimally invasive surgery.
abstract: BACKGROUND
  Surgical debridement is often required to treat spinal infections. Successful surgery requires accurate localization of the active infections, however, current imaging technique still requires surgeons' experience to narrow the surgical fields to achieve less invasive procedures.
  
  
  OBJECTIVE
  To investigate the use of F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for successful surgical planning.
  
  
  METHODS
  Nine patients with suspected spinal infection underwent magnetic resonance imaging (MRI) and FDG-PET/CT before surgery to locate active foci of infections. The spinal structures were divided into seven compartments at each intervertebral disc level for a total of 315 compartments investigated. The same classification system was used to design operating fields for histological correlation.
  
  
  RESULTS
  FDG-PET/CT diagnosed fewer compartments as active infection (34 compartments, 10.8%) than MRI (62 compartments, 19.7%, P  = 0.002). Surgical exploration was performed in 49 compartments, and demonstrated active infection in 25 compartments. The sensitivity / specificity of FDG-PET/CT was 100% / 79%, respectively, which was superior to those of MRI, 76% / 42%. Foci of active infection showed hypermetabolic activity with a SUVmax of 7.1 ± 2.6 (range, 3.0-12.7). Receiver operating characteristic (ROC) analysis indicated an optimal threshold for active spinal infection at a SUVmax of 4.2, corresponding to a sensitivity of 90.3% and specificity of 91.2%.
  
  
  CONCLUSIONS
  FDG-PET/CT demonstrated limited areas of abnormality allowing accurate delineation, and is thus useful to narrow the surgical fields. Since overall diagnostic accuracy of FDG-PET/CT was superior to that of MRI, FDG-PET/CT is a useful technique to narrow the surgical field for successful less invasive surgery.
authors: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Masayuki
authors: M
authors: Nakahara
authors: Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Manabu
authors: M
authors: Ito
authors: Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan nhattori@med.hokudai.ac.jp.
authors: Naoya
authors: N
authors: Hattori
authors: Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Keiichi
authors: K
authors: Magota
authors: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Masahiko
authors: M
authors: Takahata
authors: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Ken
authors: K
authors: Nagahama
authors: Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Hideki
authors: H
authors: Sudo
authors: Faculty of Health Science, Hokkaido University, Sapporo, Japan.
authors: Tamotsu
authors: T
authors: Kamishima
authors: Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Nagara
authors: N
authors: Tamaki
authors: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Norimasa
authors: N
authors: Iwasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis* / Q000601:surgery*; D003287:Contrast Media; D015299:Discitis / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019786:Gadolinium DTPA
keywords: Fluorodeoxyglucose F18; adult; infection; magnetic resonance imaging; positron emission tomography; spine