Skip to main content

Nuclear Medicine Imaging of Spinal Infection

  • Chapter
  • First Online:
Imaging of Spinal Infection

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

Abstract

Spinal infection can be challenging to diagnose accurately, as symptoms can be insidious and nonspecific. Advanced radiological imaging procedures can be very useful to aid diagnosis. Nuclear medicine imaging can provide significant information, in addition to more conventional imaging techniques such as radiography and MRI. Nuclear medicine imaging (SPECT and PET) have shown high sensitivity and accuracy with regard to spinal infection diagnosis, especially when used in combination with conventional radiological investigations such as CT and MRI. By providing additional functional information, nuclear medicine imaging helps to identify possible sites for biopsy, monitor treatment responses, and guide the duration of antimicrobial treatment. Expert consensus guidelines have been published, addressing the use and implementation of nuclear medicine imaging techniques in spinal infection.

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

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

[18F] FDG:

Fluorine-18 2′-deoxy-2-fluoro-d-glucose

67Ga:

Gallium-67

99mTc:

Technetium-99m

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

SPECT:

Single photon emission computed tomography

References

  • Asti M, Iori M, Erba PA et al (2012) Radiosynthesis of 68Ga-labelled DOTA–biocytin (68Ga-r-BHD) and assessment of its pharmaceutical quality for clinical use. Nucl Med Commun 33:1179–1187

    Article  CAS  PubMed  Google Scholar 

  • Bar-shalom R, Yefremov N, Guralnik L et al (2006) Leukocyte scintigraphy for diagnosis of infection. J Nucl Med 47:587–594

    PubMed  Google Scholar 

  • Dauchy FA, Dutertre A, Lawson-Ayayi S et al (2016) Interest of [18 F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of relapse in patients with spinal infection: a prospective study. Clin Microbiol Infect 22:438–443

    Google Scholar 

  • De Winter F, Gemmel F, Van De Wiele C et al (2003) 18-Fluorine fluorodeoxyglucose positron emission tomography for the diagnosis of infection in the postoperative spine. Spine (Phila Pa) 28:1314–1319

    Article  Google Scholar 

  • De Winter F, Gemmel F, Van Laere K et al (2004) 99mTc-Ciprofloxacin planar and tomographic imaging for the diagnosis of infection in the postoperative spine: experience in 48 patients. Eur J Nucl Med Mol Imaging 31:233–239

    Article  PubMed  Google Scholar 

  • Dillmann-Arroyo C, Cantú-Leal R, Campa-Núñez H et al (2011) [Application of the ubiquicidin 29-41 scan in the diagnosis of pyogenic vertebral osteomyelitis]. Acta Ortop Mex 25:27–31

    Google Scholar 

  • Erba PA, Israel O (2014) SPECT/CT in infection and inflammation. Clin Transl Imaging 2:519–535

    Article  Google Scholar 

  • Fahnert J, Purz S, Jarvers JS et al (2016) Use of simultaneous 18F-FDG PET/MRI for the detection of spondylodiskitis. J Nucl Med 57:1396–1401

    Article  CAS  PubMed  Google Scholar 

  • Freesmeyer M, Stecker FF, Schierz J-H et al (2014) First experience with early dynamic 18F-NaF-PET/CT in patients with chronic osteomyelitis. Ann Nucl Med 28:314–321

    Article  CAS  PubMed  Google Scholar 

  • Fuster D, Solà O, Soriano A et al (2012) A prospective study comparing whole-body FDG PET/CT to combined planar bone scan with 67Ga SPECT/CT in the diagnosis of spondylodiskitis. Clin Nucl Med 37:827–832

    Google Scholar 

  • Gemmel F, Dumarey N, Palestro CJ (2006) Radionuclide imaging of spinal infections. Eur J Nucl Med Mol Imaging 33:1226–1237

    Article  PubMed  Google Scholar 

  • Gemmel F, Rijk PC, Collins JMP et al (2010) Expanding role of 18F-fluoro-d-deoxyglucose PET and PET/CT in spinal infections. Eur Spine J 19:540–551

    Article  PubMed  PubMed Central  Google Scholar 

  • Gratz S, Dörner J, Oestmann JW et al (2000) 67Ga-Citrate and 99Tcm-MDP for estimating the severity of vertebral osteomyelitis. Nucl Med Commun 21:111–120

    Article  CAS  PubMed  Google Scholar 

  • Gratz S, Dörner J, Fischer U et al (2002) 18F-FDG hybrid PET in patients with suspected spondylitis. Eur J Nucl Med 29:516–524

    Article  CAS  Google Scholar 

  • Guhlmann A, Brecht-Krauss D, Suger G et al (1998) Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis. J Nucl Med 39:2145–2152

    CAS  PubMed  Google Scholar 

  • Gunes BY, Onsel C, Sonmezoglu K et al (2016) Diagnostic value of F-18 FDG PET/CT in patients with spondylodiscitis: is dual time point imaging time worthy? Diagn Microbiol Infect Dis 85:381–385

    Article  PubMed  Google Scholar 

  • Hartmann A, Eid K, Dora C et al (2007) Diagnostic value of 18F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis. Eur J Nucl Med Mol Imaging 34:704–714

    Article  PubMed  Google Scholar 

  • Hong SH, Choi JY, Lee JW et al (2009) MR imaging assessment of the spine: infection or an imitation? Radiographics 29:599–612

    Google Scholar 

  • Hungenbach S, Delank K-S, Dietlein M et al (2013) 18F-fluorodeoxyglucose uptake pattern in patients with suspected spondylodiscitis. Nucl Med Commun 34:1068–1074

    Article  CAS  PubMed  Google Scholar 

  • Kälicke T, Schmitz A, Risse JH et al (2000) Fluorine-18 fluorodeoxyglucose positron emission tomography in infectious bone diseases: results of histologically confirmed cases. Eur J Nucl Med Mol Imaging 27:524–528

    Article  Google Scholar 

  • Kannivelu A, Kok TY, Padhy AK (2012) The conundrum of PET/MR. World J Nucl Med 11:1–2

    Article  PubMed  PubMed Central  Google Scholar 

  • Kannivelu A, Loke KSH, Kok TY et al (2014) The role of PET/CT in the evaluation of skeletal metastases. Semin Musculoskelet Radiol 18:149–165

    Article  PubMed  Google Scholar 

  • Khoo LA, Heron C, Patel U et al (2003) The diagnostic contribution of the frontal lumbar spine radiograph in community referred low back pain—a prospective study of 1030 patients. Clin Radiol 58:606–609

    Article  CAS  PubMed  Google Scholar 

  • Kim SJ, Lee JS, Suh KT et al (2008) Differentiation of tuberculous and pyogenic spondylitis using double phase F-18 FDG PET. Open Med Imaging J 2:1–6

    Google Scholar 

  • Lazzeri E, Manca M, Molea N et al (1999) Clinical validation of the avidin/indium-111 biotin approach for imaging infection/inflammation in orthopaedic patients. Eur J Nucl Med 26:606–614

    Article  CAS  PubMed  Google Scholar 

  • Lazzeri E, Pauwels EKJ, Erba PA et al (2004) Clinical feasibility of two-step streptavidin/111In-biotin scintigraphy in patients with suspected vertebral osteomyelitis. Eur J Nucl Med Mol Imaging 31:1505–1511

    Article  PubMed  Google Scholar 

  • Lazzeri E, Erba P, Perri M et al (2010) Clinical impact of SPECT/CT with In-111 biotin on the management of patients with suspected spine infection. Clin Nucl Med 35:12–17

    Article  PubMed  Google Scholar 

  • Lazzeri E, Bozzao A, Cataldo MA et al (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 

  • Lee JW, Yu SN, Yoo ID et al (2019) Clinical application of dual-phase F-18 sodium-fluoride bone PET/CT for diagnosing surgical site infection following orthopedic surgery. Medicine (Baltimore) 98:e14770

    Article  Google Scholar 

  • Lisbona R, Derbekyan V, Novales-Diaz J, Veksler A (1993) Gallium-67 scintigraphy in tuberculous and nontuberculous infectious spondylitis. J Nucl Med 34:853–859

    CAS  PubMed  Google Scholar 

  • Love C, Palestro CJ (2016) Nuclear medicine imaging of bone infections. Clin Radiol 71:632–646

    Article  CAS  PubMed  Google Scholar 

  • Love C, Patel M, Lonner BS et al (2000) Diagnosing spinal osteomyelitis: a comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. Clin Nucl Med 25:963–977

    Article  CAS  PubMed  Google Scholar 

  • Mylona E, Samarkos M, Kakalou E et al (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 39:10–17

    Article  CAS  PubMed  Google Scholar 

  • Nanni C, Errani C, Boriani L et al (2010) 68Ga-Citrate PET/CT for evaluating patients with infections of the bone: preliminary results. J Nucl Med 51:1932–1936

    Article  PubMed  Google Scholar 

  • Nanni C, Boriani L, Salvadori C et al (2012) FDG PET/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 39:1538–1544

    Article  PubMed  Google Scholar 

  • Ohtori S, Suzuki M, Koshi T et al (2010) 18F-Fluorodeoxyglucose-PET for patients with suspected spondylitis showing Modic change. Spine (Phila Pa) 35:E1599–E1603

    Article  Google Scholar 

  • Palestro CJ (2013) FDG-PET in musculoskeletal infections. Semin Nucl Med 43:367–376

    Article  PubMed  Google Scholar 

  • Palestro CJ (2016) Radionuclide imaging of musculoskeletal infection: a review. J Nucl Med 57:1406–1412

    Article  CAS  PubMed  Google Scholar 

  • Palestro CJ, Love C (2007) Radionuclide imaging of musculoskeletal infection: conventional agents. Semin Musculoskelet Radiol 11:335–352

    Article  PubMed  Google Scholar 

  • Palestro CJ, Kim CK, Swyer AJ et al (1991) Radionuclide diagnosis of vertebral osteomyelitis: indium-111-leukocyte and technetium-99m-methylene diphosphonate bone scintigraphy. J Nucl Med 32:1861–1865

    CAS  PubMed  Google Scholar 

  • Palestro CJ, Glaudemans AWJM, Dierckx RAJO (2013) Multiagent imaging of inflammation and infection with radionuclides. Clin Transl Imaging 1:385–396

    Article  PubMed  PubMed Central  Google Scholar 

  • Prandini N, Lazzeri E, Rossi B et al (2006) Nuclear medicine imaging of bone infections. Nucl Med Commun 27:633–644

    Article  PubMed  Google Scholar 

  • Prodi E, Grassi R, Iacobellis F, Cianfoni A (2016) Imaging in spondylodiskitis. Magn Reson Imaging Clin N Am 24:581–600

    Article  PubMed  Google Scholar 

  • Raghavan M, Lazzeri E, Palestro CJ (2018) Imaging of spondylodiscitis. Semin Nucl Med 48:131–147

    Article  PubMed  Google Scholar 

  • 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 

  • Rosen RS, Fayad L, Wahl RL (2006) Increased 18F-FDG uptake in degenerative disease of the spine: characterization with 18F-FDG PET/CT. J Nucl Med 47:1274–1280

    CAS  PubMed  Google Scholar 

  • Saha S, Burke C, Desai A et al (2013) SPECT-CT: applications in musculoskeletal radiology. Br J Radiol 86:1–15

    Article  Google Scholar 

  • Schmitz A, Risse J, Grünwald F et al (2001) Fluorine-18 fluorodeoxyglucose positron emission tomography findings in spondylodiscitis: preliminary results. Eur Spine J 10:534–539

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Seifen T, Rettenbacher L, Thaler C et al (2012) Prolonged back pain attributed to suspected spondylodiscitis. Nuklearmedizin 51:194–200

    Article  CAS  PubMed  Google Scholar 

  • Skanjeti A, Penna D, Douroukas A et al (2012) PET in the clinical work-up of patients with spondylodiscitis: a new tool for the clinician? Q J Nucl Med Mol Imaging 56:569–576

    CAS  PubMed  Google Scholar 

  • Stumpe KDM, Zanetti M, Weishaupt D et al (2002) FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol 179:1151–1157

    Article  PubMed  Google Scholar 

  • Thang S, Tong A, Lam W, Ng D (2014) SPECT/CT in musculoskeletal infections. Semin Musculoskelet Radiol 18:194–202

    Article  PubMed  Google Scholar 

  • Treglia G, Pascale M, Lazzeri E et al (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 

  • Yapar Z, Kibar M, Yapar AF et al (2001) The efficacy of technetium-99m ciprofloxacin (Infecton) imaging in suspected orthopaedic infection: a comparison with sequential bone/gallium imaging. Eur J Nucl Med 28:822–830

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anbalagan Kannivelu .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kannivelu, A., Tong, A.K.T., Loke, K.S.H., Ng, D.C.E. (2021). Nuclear Medicine Imaging of Spinal Infection. In: Ladeb, M.F., Peh, W.C. (eds) Imaging of Spinal Infection. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-030-70459-9_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-70459-9_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-70458-2

  • Online ISBN: 978-3-030-70459-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics