Skip to main content
Log in

[18F]FDG PET/CT imaging of spinal infections

  • Research
  • Published:
Clinical and Translational Imaging Aims and scope Submit manuscript

Abstract

The annual incidence of spinal infections has been rising significantly over the last years and is expected to increase even further. Spinal infections may include infection of the vertebral body and intervertebral disc (spondylodiscitis), paravertebral abscess, epidural abscess and septic arthritis of the facet joints. Positron emission tomography (PET) with [18F]FDG has high sensitivity for detecting spinal infections, may help in differentiating between spinal infection subtypes and is able to detect dissemination of infection outside the spine. [18F]FDG PET/CT is especially indicated if MRI is inconclusive, in patients with contra-indications for MRI, in postoperative patients with or without spinal hardware and in patients with bacteremia to find foci of infection. Here, we present a concise overview of the spectrum of [18F]FDG PET/CT imaging findings in spinal infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

Data Availability

Not applicable.

References

  1. Conan Y, Laurent E, Belin Y, Lacasse M, Amelot A, Mulleman D, Rosset P, Bernard L, Grammatico-Guillon L (2021) Large increase of vertebral osteomyelitis in France: a 2010–2019 cross-sectional study. Epidemiol Infect 149:e227

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kramer A, Thavarajasingam SG, Neuhoff J, Ponniah HS, Ramsay DSC, Demetriades AK, Davies BM, Shiban E, Ringel F (2023) Epidemiological trends of pyogenic spondylodiscitis in Germany: an EANS spine section study. Sci Rep 13:20225

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lazzeri E, Bozzao A, Cataldo MA, Petrosillo N, Manfrè L, Trampuz A, Signore A, Muto M (2019) Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults. Eur J Nucl Med Mol Imaging 46:2464–2487

    Article  PubMed  Google Scholar 

  4. Babic M, Simpfendorfer CS (2017) Infections of the spine. Infect Dis Clin N Am 31:279–297

    Article  Google Scholar 

  5. Hadjipavlou A, Mader JT, Necessary JT, Muffolletto AJ (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine 25:1668–1679

    Article  CAS  PubMed  Google Scholar 

  6. Raghavan M, Palestro CJ (2022) Imaging of spondylodiscitis: an update. Semin Nucl Med 53:152–166

    Article  PubMed  Google Scholar 

  7. Treglia G, Pascale M, Lazzeri E, Van der Bruggen W, Delgado Bolton RC, Glaudemans AWJM (2020) Diagnostic performance of 18F-FDG PET/CT in patients with spinal infection: a systematic review and a bivariate meta-analysis. Eur J Nucl Med Mol Imaging 47:1287–1301

    Article  PubMed  Google Scholar 

  8. Kouijzer IJE, Scheper H, De Rooy JWJ, Bloem JL, Janssen MJR, Van den Hoven L, Hosman AJF, Visser LG, Oyen WJG, Bleeker-Rovers CP, De Geus-Oei LF (2018) The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis—a prospective study. Eur J Nucl Med Mol Imaging 45:798–805

    Article  CAS  PubMed  Google Scholar 

  9. Maamari J, Grach SL, Passerini M, Kinzelman-Vesely EA, Nassr A, Carr C, Diehn FE, Tande AJ, Murad MH, Berbari EF (2023) The use of MRI, PET/CT, and nuclear scintigraphy in the imaging of pyogenic native vertebral osteomyelitis: a systematic review and meta-analysis. Spine J 23:868–876

    Article  PubMed  Google Scholar 

  10. Kim SJ, Pak K, Kim K, Lee JS (2019) Comparing the diagnostic accuracies of F-18 fluorodeoxyglucose positron emission tomography and magnetic resonance imaging for the detection of spondylodiscitis: a meta-analysis. Spine 44:E414–E422

    Article  PubMed  Google Scholar 

  11. Yin Y, Liu X, Yang X, Guo J, Wang Q, Chen L (2018) Diagnostic value of FDG-PET versus magnetic resonance imaging for detecting spondylitis: a systematic review and meta-analysis. Spine J 18:2323–2332

    Article  PubMed  Google Scholar 

  12. Smids C, Kouijzer IJE, Vos FJ, Sprong T, Hosman AJF, De Rooy JWJ, Aarntzen EHJG, De Geus-Oei LF, Oyen WJG, Bleeker-Rovers CP (2017) A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis. Infection 45:41–49

    Article  PubMed  Google Scholar 

  13. Segawa T, Koga H, Oshina M, Fukushima M, Inanami H (2021) The diagnostic value of Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography for the detection of surgical site infection after spine surgery. Spine 46:E602–E610

    Article  PubMed  Google Scholar 

  14. Paez D, Sathekge MM, Douis H, Giammarile F, Fatima S, Dhal A, Puri SK, Erba PA, Lazzeri E, Ferrando R, Filho PA, Magboo VP, Morozova O, Núñez R, Pellet O, Mariani G (2021) Comparison of MRI, [18F]FDG PET/CT, and 99mTc-UBI 29–41 scintigraphy for postoperative spondylodiscitis—a prospective multicenter study. Eur J Nucl Med Mol Imaging 48:1864–1875

    Article  CAS  PubMed  Google Scholar 

  15. Russo A, Graziano E, Carnelutti A, Sponza M, Cadeo B, Sartor A, Righi E, Bassetti M (2019) Management of vertebral osteomyelitis over an eight-year period: the UDIPROVE (UDIne PROtocol on VErtebral osteomyelitis). Int J Infect Dis 89:116–121

    Article  CAS  PubMed  Google Scholar 

  16. Righi E, Carnelutti A, Muser D, Di Gregorio F, Cadeo B, Melchioretto G, Merelli M, Alavi A, Bassetti M (2020) Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis. Skeletal Radiol 49:903–912

    Article  PubMed  Google Scholar 

  17. Riccio SA, Chu AKM, Rabin HR, Kloiber R (2015) Fluorodeoxyglucose positron emission tomography/computed tomography interpretation criteria for assessment of antibiotic treatment response in pyogenic spine infection. Can Assoc Radiol J 66:145–152

    Article  PubMed  Google Scholar 

  18. Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollìni M, Versari A, Signore A (2021) State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 9:299–339

    Article  PubMed  PubMed Central  Google Scholar 

  19. McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34:1342–1350

    Article  PubMed  Google Scholar 

  20. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 39:10–17

    Article  CAS  PubMed  Google Scholar 

  21. Leone A, Dell’Atti C, Magarelli N, Colelli P, Balanika A, Casale R, Bonomo L (2012) Imaging of spondylodiscitis. Eur Rev Med Pharmacol Sci 16(suppl 2):8–19

    PubMed  Google Scholar 

  22. Duarte RM, Vaccaro AR (2013) Spinal infection: state of the art and management algorithm. Eur Spine J 22:2787–2799

    Article  PubMed  PubMed Central  Google Scholar 

  23. D’Agostino C, Scorzolini L, Massetti AP, Carnevalini M, d’Ettorre G, Venditti M, Vullo V, Orsi GB (2010) A seven-year prospective study on spondylodiscitis: epidemiological and microbiological features. Infection 38:102–107

    Article  PubMed  Google Scholar 

  24. Hungenbach S, Delank KS, Dietlein M, Eysel P, Drzezga A, Schmidt MC (2013) 18F-fluorodeoxyglucose uptake pattern in patients with suspected spondylodiscitis. Nucl Med Commun 34:1068–1074

    Article  CAS  PubMed  Google Scholar 

  25. Zimmerer SME, Conen A, Müller AA, Sailer M, Taub E, Flückiger U, Schwenzer-Zimmerer KC (2011) Spinal epidural abscess: aetiology, predisponent factors and clinical outcomes in a 4-year prospective study. Eur Spine J 20:2228–2234

    Article  PubMed  PubMed Central  Google Scholar 

  26. Patel AR, Alton TB, Bransford RJ, Lee MJ, Bellabarba CB, Chapman JR (2014) Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J 14:326–330

    Article  PubMed  Google Scholar 

  27. Babic M, Ilaslan H, Shrestha N, Simpfendorfer CS (2020) Isolated septic facet joints: an underdiagnosed distinct clinical entity. Skeletal Radiol 49:1295–1303

    Article  PubMed  Google Scholar 

  28. Fahnert J, Purz S, Jarvers JS, Heyde CE, Barthel H, Stumpp P, Kahn T, Sabri O, Friedrich B (2016) Use of simultaneous 18F-FDG PET/MRI for the detection of spondylodiskitis. J Nucl Med 57:1396–1401

    Article  CAS  PubMed  Google Scholar 

  29. Cherry SR, Jones T, Karp JS, Qi J, Moses WW, Badawi RD (2018) Total-body PET: maximizing sensitivity to create new opportunities for clinical research and patient care. J Nucl Med 59:3–12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Welling MM, Hensbergen AW, Bunschoten A, Velders AH, Roestenberg M, Van Leeuwen FWB (2019) An update on radiotracer development for molecular imaging of bacterial infections. Clin Transl Imaging 7:105–124

    Article  Google Scholar 

Download references

Funding

No funding was received for this work.

Author information

Authors and Affiliations

Authors

Contributions

EtB, MtB and SAF: data collection. All authors: manuscript writing.

Corresponding author

Correspondence to Erik T. te Beek.

Ethics declarations

Conflict of interest

The authors declare no competing interests for this work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

te Beek, E.T., ten Broek, M.R.J., Abdul-Fatah, S. et al. [18F]FDG PET/CT imaging of spinal infections. Clin Transl Imaging (2024). https://doi.org/10.1007/s40336-024-00629-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40336-024-00629-0

Keywords

Navigation