gms | German Medical Science

Objective: MRI is the diagnostic modality of choice for detecting spondylodiscitis, but often can't be applied because of claustrophobia, pace-maker, metallic implants, patient's intolerance, bad general condition or nephropathia. Aim of this study was to demonstrate the potential of fluorine-18 fluorodeoxyglucose PET/CT (18F-FDG PET/CT) in patients (pts.) with suspected unclear infection in spinal column.

Method: 10 pts. (male: n=5, female n=5, mean age 57.5 ys.) suffering from unclear diffuse back pain and suspected infection in spinal column were examined.

Results: PET/CT imaging could visualize inflammation process in 10/10 pts. In one patient back pain could be explained by an osseous metastasis, proved by histopathology (prostate cancer). In 3/20 pts. unclear diffuse back pain was caused by postoperative bacterious infections, proved by bacteriological culture after CT-interventional guided biopsy. In one of these three pts. PET/CT results yielded to the unambiguous assignment in an unclear clinical situation, 2/3 pts. PET/CT guided surgery could be performed. Primary spondylodiscitis could be represented by PET/CT in 7/10 pts. In 2/7 pts. diagnosis was confirmed by operation procedure with intraoperative sampling and pain-controlled follow-up (6 mos.) after systemic antibiotic therapy. In 5/7 pts. treatment establishment of standard therapeutic guidelines caused by limited extent. In these pts. clinical symptoms relieved after a mean follow-up of 4.5 months.

Conclusions: In cases of missing Gadolineum-enhanced MRI performance 18F-FDG PET/CT is helpful as an adjunct, effective, reliable non-invasive diagnostic tool for visualization of spondylodiszitis,- especially in patients in whom diagnosis of spondylodiscitis is inconclusive. In contrast to MRI-Imaging PET/CT has the potential to distinguish between initial spondylodiscitis and degenerative changes in the vertebral body endplates. As rapid whole body 3D-imaging PET/CT demonstrate both infection loci in the whole body and a specific differentiation from malignant processes.