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Open Access Research article

Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan contributes to the diagnosis and management of brucellar spondylodiskitis

Savvas Ioannou1*, Sofia Chatziioannou2, Spiros G Pneumaticos3, Alexandra Zormpala4 and Nikolaos V Sipsas1

Author Affiliations

1 Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 115 27, Athens, Greece

2 Department of Radiology, Center for Clinical Research, Nuclear medicine and PET/CT Section, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece

3 Department of Orthopaedics, KAT General Hospital, and Medical School, National and Kapodistrian University of Athens, Athens, Greece

4 Radiology Department, Laikon General Hospital, and Medical School, National and Kapodistrian University of Athens, Athens, Greece

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BMC Infectious Diseases 2013, 13:73  doi:10.1186/1471-2334-13-73

Published: 7 February 2013

Abstract

Background

Limited data suggest that fluorine-18 fluoro-2-deoxy-D-glucose (F-18 FDG) positron emission tomography combined with computed tomography (PET/CT) scan may be useful for diagnosing infections of the spine. Brucellar spondylodiskitis might be devastating and current imaging techniques lack sensitivity and specificity. The aim of this prospective study was to determine the role of F-18 FDG PET/CT scan in the diagnosis of brucellar spondylodiskitis and in monitoring the efficacy of its treatment.

Methods

Ten consecutive patients with brucellar spondylitis were prospectively evaluated with PET/CT. Baseline evaluation included also magnetic resonance imaging (MRI) of the affected spine, indices of inflammation, the slide agglutination test (SAT), and the standard hematology and biochemistry. All cases were treated with suitable antibiotics until resolution or significant improvement of clinical and radiological (MRI) findings. Upon completion of treatment, they were re-evaluated with follow-up PET/CT scan. The maximum standardized uptake values (SUV) were measured and compared with SAT.

Results

In all patients there was an increased F-18 FDG activity in the infected spine region detected by the initial MRI. F-18 FDG PET/CT provided additional information, compared to MRI, in 4 (40%) patients. More specifically it revealed additional spine lesions (in 3 patients), lymphadenitis, arthritis, organomegaly, as well as new paravertebral soft tissue involvement and epidural masses. This additional information had an impact on the duration of treatment in these patients. At the end of treatment all patients had a complete clinical response; 5 patients had positive serology, 6 patients had residual MRI findings, while 9 had a positive PET/CT but with significantly decreased FDG uptake compared to baseline (median 2.6, range 1.4 – 4.4 vs. median 5.5, range 2.8 – 9.4, p = 0.005). During the follow up period (median 12.5 months) no relapses have been observed. No significant association was observed between the SUV and SAT.

Conclusions

Our study suggests that in patients with brucellar spondylodiskitis F-18 FDG PET/CT scan can provide additional information on the spread of the infection, compared to MRI. Successful treatment is associated with a significant decrease in SUVmax values; thus, PET/CT scan may be a complementary method for determining the efficacy of treatment.

Keywords:
Brucella; Spondylodiskitis; Positron emission tomography; Standardized uptake value