Abstract
Purpose: The clinical and radiological abnormal findings continue even after successful treatment in pyogenic vertebral osteomyelitis (PVO). We analyzed the clinical and radiological features of cured PVO based on 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (FDG-PET/MRI) and compared the radiological differences between FDG-PET and MRI for assessing therapeutic response in PVO. Methods: This study included 43 patients (28 men and 15 women) with lumbar PVO who had no recurrence after successful antimicrobial therapy. They were divided into two groups based on the location of maximum standardized FDG uptake value (SUVmax) of PVO lesion on FDG-PET/MRI when parenteral antibiotics were discontinued (31 in group A: Intervertebral structure; 12 in group B: Vertebral body and paravertebral muscle). The differences of clinical symptoms, hematological inflammatory indices, and radiological features were retrospectively analyzed. Results: The patients were treated with 42.28 ± 14.58 (21–89) days of parenteral antibiotics. There were significant differences in C-reactive protein (0.97 ± 1.10 vs. 0.51 ± 0.31 mg/dL, p = 0.041; normal range of CRP < 0.5), back pain (4.29 ± 1.13 vs. 3.50 ± 1.00, p = 0.040; visual analog scale), and SUVmax (4.34 ± 1.24 vs. 5.89 ± 1.57, p < 0.001) between the two groups. In the distribution pattern of PVO lesions, FDG-PET overall showed recovery pattern earlier than MRI did (p < 0.001). Conclusions: In cured PVO, the clinical features vary depending on the location of major structural damage of PVO lesion. The involvement of intervertebral structure is related with sustained back pain and elevation of CRP, and vertebral body/paravertebral muscle shows favorable clinical features despite advanced structural damages.
Highlights
Pyogenic vertebral osteomyelitis (PVO) is usually treated conservatively with long-term antibiotics, administered for six to 12 weeks in patients with no other complications
The clinical and radiological abnormal findings often continue even after successful antimicrobial therapy in PVO. It is hard for magnetic resonance imaging (MRI) to distinguish between residual PVO lesions and structural changes resulting from tissue damages; it can show a worsened condition compared to previous examinations because tissue damages can take several months to resolve in cases demonstrating clinical recovery [7,8]
FDG uptake on fluorodeoxyglucose positron emission tomography (FDG-PET) showed differences according to the condition of each portion within the PVO lesion in greater detail compared to MRI
Summary
Pyogenic vertebral osteomyelitis (PVO) is usually treated conservatively with long-term antibiotics, administered for six to 12 weeks in patients with no other complications. The clinical and radiological abnormal findings often continue even after successful antimicrobial therapy in PVO It is hard for magnetic resonance imaging (MRI) to distinguish between residual PVO lesions and structural changes resulting from tissue damages; it can show a worsened condition compared to previous examinations because tissue damages can take several months to resolve in cases demonstrating clinical recovery [7,8]. These limitations may lead to confusion in the assessment of therapeutic response and result in the use of unnecessary antibiotics or recurrence due to insufficient treatment
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