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Observational Study
. 2020 Jun;49(6):903-912.
doi: 10.1007/s00256-019-03328-4. Epub 2020 Jan 4.

Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis

Elda Righi  1   2 , Alessia Carnelutti  3 , Daniele Muser  4 , Fernando Di Gregorio  5 , Barbara Cadeo  3 , Giulia Melchioretto  3 , Maria Merelli  3 , Abass Alavi  6 , Matteo Bassetti  3   7
Affiliations
Observational Study

Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis

Elda Righi et al. Skeletal Radiol. 2020 Jun.

Abstract

Objective: To assess the added value of serial 2-deoxy-2-[18F]fluoro-D-glucose (FDG) uptake analysis in predicting clinical response to treatment in infectious spondylodiscitis (IS). We sought to analyze changes in quantitative FDG-PET/CT parameters among patients with clinical response or treatment failure and to compare the sensitivity and specificity of serial FDG-PET/CT and MRI in predicting treatment response in IS.

Materials and methods: This retrospective study consisted of 68 FDG-PET/CT examinations in 34 patients performed before and after at least 2 weeks of antibiotic treatment. Serial MRI scans were available in 32 (94%) patients before and after treatment. FDG-avid lesions were quantified as maximum standardized uptake value (SUVmax), partial-volume corrected lesion metabolic volume (LMV), and partial-volume corrected lesion metabolic activity (LMA).

Results: All FDG-PET/CT parameters significantly decreased in patients with clinical improvement (31/34, 91%, P < 0.001), while patients with disease progression did not show FDG-PET/CT improvement. FDG uptake decrease was similar between patients undergoing early assessment (< 6 weeks) compared with those performing FDG-PET/CT after 6 weeks of treatment. SUVmax, LMV, and LMA decrease over time was 39.0%, 97.4%, and 97.1%, respectively. In predicting clinical responses, SUVmax reduction > 15% and > 25% showed 94% and 89% sensitivity and 67% and 100% specificity compared with 37% and 50% of MRI, respectively. Low degree of agreement with clinical response was shown for MRI compared with FDG-PET/CT parameters using the Cohen kappa coefficient.

Conclusions: FDG-PET/CT monitoring is a valuable tool to predict clinical response to treatment in IS and has greater sensitivity and specificity compared with MRI.

Keywords: Fluorine-18-fluorodeoxyglucose positron emission tomography; Infectious spondylodiscitis; MRI; Quantitative FDG uptake analysis; Treatment response.

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