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The routine clinical use of fluorodeoxyglucose PET/CT to confirm treatment response in pyogenic spine infection

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Abstract

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.

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Authors and Affiliations

  1. Department of Radiology, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada

    Hans W. Lafford, Errol E. Stewart, Ingrid L. Koslowsky & Reinhard Kloiber

  2. Diagnostic Radiology Residency Program, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada

    Hans W. Lafford

  3. Department of Medicine, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada

    Harvey R. Rabin

  4. Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada

    Harvey R. Rabin

Authors
  1. Hans W. Lafford
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  2. Errol E. Stewart
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  3. Ingrid L. Koslowsky
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  4. Harvey R. Rabin
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  5. Reinhard Kloiber
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Corresponding authors

Correspondence to Hans W. Lafford or Reinhard Kloiber.

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All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lafford, H.W., Stewart, E.E., Koslowsky, I.L. et al. The routine clinical use of fluorodeoxyglucose PET/CT to confirm treatment response in pyogenic spine infection. Skeletal Radiol 53, 161–170 (2024). https://doi.org/10.1007/s00256-023-04393-6

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  • DOI: https://doi.org/10.1007/s00256-023-04393-6

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