Abstract
Purpose: There is still no definite method to determine therapeutic response in pyogenic vertebral osteomyelitis (PVO). We analyzed the value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for assessing therapeutic response in PVO. Methods: This retrospective study included 53 patients (32 men and 21 women) with lumbar PVO. The results of clinical assessments for therapeutic response were divided into “Cured” (group C) and “Non-cured” (group NC). The differences in clinical and radiological features of PVO lesions between the two groups were analyzed using clinical data and simultaneous FDG-PET/magnetic resonance imaging (MRI) obtained at each clinical assessment. Results: Clinical assessments and FDG-PET/MRIs were performed at 41.89 ± 16.08 (21–91) days of parenteral antibiotic therapy. There were 39 patients in group C and 14 in group NC. Diagnostic accuracies (DAs) of FDG uptake intensity-based interpretation and C-reactive protein (CRP) for residual PVO were as follows (p < 0.01): 84.9% of the maximum standardized uptake value of PVO lesion (PvoSUVmax), 86.8% of ΔPvoSUVmax−NmlSUVmax (SUVmax of normal vertebra), 86.8% of ΔPvoSUVmax−NmlSUVmean (SUVmean of normal vertebra), and 71.7% of CRP. DAs were better (92.5–94.3%) when applying FDG uptake intensity-based interpretation and CRP together. Under the FDG uptake distribution-based interpretation, FDG uptake was significantly limited to intervertebral structures in group C (p = 0.026). Conclusion: The interpretations of intensity and distribution of FDG uptake on FDG-PET are useful for detecting residual PVO in the assessment of therapeutic response of PVO. The combination of FDG-PET and CRP is expected to increase DA for detecting residual PVO.
Highlights
Unlike other infections, the symptoms of pyogenic vertebral osteomyelitis (PVO) are non-specific, and may not necessarily include fever [1,2]
Fifty-three of simultaneous fluorodeoxyglucose positron emission tomography (FDG-PET)/magnetic resonance imaging (MRI) were performed during the clinical assessments for therapeutic response at 41.89 ± 16.08 (21–91) days of parenteral antibiotic therapy
∆ PvoSUVmax -NmlSUVmean in the intensity-based interpretation, which use the value of FDG uptake of normal vertebrae as the reference instead of comparing with the value of pre-treatment PVO lesion on the initial image
Summary
The symptoms of pyogenic vertebral osteomyelitis (PVO) are non-specific, and may not necessarily include fever [1,2]. Before diagnosis, PVO would have already progressed, and vertebral and discal damages become severe with abscesses in the epidural space or paravertebral soft tissues [3]. PVO is usually treated conservatively with long-term antibiotics; a treatment duration of six to twelve weeks is recommended for patients without other complications [1,5,6,7]. A study that conducted under the same medical environment this study reported that an average duration of 8.0 ± 4.1 weeks of intravenous antibiotics administration was required to treat PVO [8]. A recent guideline recommended six weeks of parenteral or highly
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