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Joint Bone Spine. 2019 Jan 31. pii: S1297-319X(19)30008-9. doi: 10.1016/j.jbspin.2019.01.009. [Epub ahead of print]

Added value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography for the diagnosis of post-operative instrumented spine infection.

Author information

1
Department of Infectious and Tropical Diseases, Hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France; Centre de Référence Infections Ostéo-Articulaires Complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France.
2
Centre de Référence Infections Ostéo-Articulaires Complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France; Service de Médecine Nucléaire, Hôpital Pellegrin, 33076 Bordeaux, France; INCIA, UMR, CNRS 5287, Université de Bordeaux, 33076 Bordeaux, France.
3
INSERM U1219 Bordeaux Population Health, ISPED, University of Bordeaux, 33076 Bordeaux, France.
4
Centre de Référence Infections Ostéo-Articulaires Complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France; Spine Unit One, Orthopaedic Surgery, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.
5
Centre de Référence Infections Ostéo-Articulaires Complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France; Department of Infectious and Tropical Diseases, CHU de Toulouse, Toulouse, France.
6
Centre de Référence Infections Ostéo-Articulaires Complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France; Department of Infectious and Tropical Diseases, CHU de Limoges, Limoges, France.
7
Department of Infectious and Tropical Diseases, Hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France; Centre de Référence Infections Ostéo-Articulaires Complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France; INSERM U1219 Bordeaux Population Health, ISPED, University of Bordeaux, 33076 Bordeaux, France. Electronic address: frederic.dauchy@chu-bordeaux.fr.

Abstract

PURPOSE:

Post-operative instrumented spine infection (PISI) is an infrequent complication. Diagnosis of spinal implant infection can be difficult, especially in case of chronic infection.

METHODS:

This retrospective study attempts to evaluate the diagnostic performance of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in PISI. Imagings were performed between April 2010 and June 2018 among patients referred for suspected chronic spinal implant infection. PET/CT were performed more than 12 weeks after surgery. PET/CT images were re-interpreted independently by two nuclear medicine physicians without knowledge of the patient's conditions. PET/CT data were analyzed both visually and semi-quantitatively (SUVmax). MRI results were collected from medical records. The final diagnosis of infection was based on bacteriological cultures or a twelve-month follow-up.

RESULTS:

Forty-nine PET/CT were performed in 44 patients (22 women, median age 65.0 years). Twenty-two patients had a diagnosis of infection during follow-up. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PET/CT were 86.4%, 81.5%, 79.2%, and 88.0%. Sensitivity, specificity, PPV and NPV were 66.7%, 75.0%, 66.0%, 75.0% respectively for MRI and 50.0%, 92.6%, 84.6% and 69.4% for serum C-reactive protein (CRP). Although these values were higher for PET/CT than for MRI or CRP, the differences were not statistically significant. In this setting, false positives with PET/CT can be observed in case of previous spine infection or adjacent segments disc disease. False negatives can result of extensive instrumented arthrodesis or infection with low virulence bacteria.

CONCLUSION:

PET/CT is useful for the diagnosis of PISI. These results should be evaluated in further prospective study.

KEYWORDS:

[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography; implant; spine infection

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