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Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis

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Abstract

Objective

To assess the added value of serial 2-deoxy-2-[18F]fluoro-D-glucose (FDG) uptake analysis in predicting clinical response to treatment in infectious spondylodiscitis (IS). We sought to analyze changes in quantitative FDG-PET/CT parameters among patients with clinical response or treatment failure and to compare the sensitivity and specificity of serial FDG-PET/CT and MRI in predicting treatment response in IS.

Materials and methods

This retrospective study consisted of 68 FDG-PET/CT examinations in 34 patients performed before and after at least 2 weeks of antibiotic treatment. Serial MRI scans were available in 32 (94%) patients before and after treatment. FDG-avid lesions were quantified as maximum standardized uptake value (SUVmax), partial-volume corrected lesion metabolic volume (LMV), and partial-volume corrected lesion metabolic activity (LMA).

Results

All FDG-PET/CT parameters significantly decreased in patients with clinical improvement (31/34, 91%, P < 0.001), while patients with disease progression did not show FDG-PET/CT improvement. FDG uptake decrease was similar between patients undergoing early assessment (< 6 weeks) compared with those performing FDG-PET/CT after 6 weeks of treatment. SUVmax, LMV, and LMA decrease over time was 39.0%, 97.4%, and 97.1%, respectively. In predicting clinical responses, SUVmax reduction > 15% and > 25% showed 94% and 89% sensitivity and 67% and 100% specificity compared with 37% and 50% of MRI, respectively. Low degree of agreement with clinical response was shown for MRI compared with FDG-PET/CT parameters using the Cohen kappa coefficient.

Conclusions

FDG-PET/CT monitoring is a valuable tool to predict clinical response to treatment in IS and has greater sensitivity and specificity compared with MRI.

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Authors and Affiliations

  1. Infectious Diseases Division, Santa Maria della Misericordia University Hospital, 50, Colugna Street, 33100, Udine, Italy

    Elda Righi, Alessia Carnelutti, Barbara Cadeo, Giulia Melchioretto, Maria Merelli & Matteo Bassetti

  2. Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro, Verona, Italy

    Elda Righi

  3. Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Daniele Muser

  4. Division of Nuclear Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy

    Fernando Di Gregorio

  5. Nuclear Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Abass Alavi

  6. Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino - IRCCS, Genoa, Italy

    Matteo Bassetti

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  1. Elda Righi
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  2. Alessia Carnelutti
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  3. Daniele Muser
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  4. Fernando Di Gregorio
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  9. Matteo Bassetti
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Correspondence to Elda Righi.

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The local institutional review board approved the study. Informed consent was waived due to the retrospective nature of the study.

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Elda Righi and Daniele Muser equally contributed to this manuscript.

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Righi, E., Carnelutti, A., Muser, D. et al. Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis. Skeletal Radiol 49, 903–912 (2020). https://doi.org/10.1007/s00256-019-03328-4

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