Clinical and Radiological Features Predicting Intervertebral Autofusion after Successful Antibiotic Therapy in Pyogenic Vertebral Osteomyelitis

Background: Pyogenic vertebral osteomyelitis (PVO) is a bacterial infection involving the intervertebral disc, vertebral body, and paravertebral soft tissues. Damaged intervertebral structure is a major cause of persistent back pain even after successful antibiotic therapy, which can be improved by achieving autofusion or via additional surgical fixation. In this study, we analyzed the clinical and radiological features predicting intervertebral autofusion after successful antibiotic therapy in lumbar PVO. Methods: This study was retrospectively conducted with 32 patients (20 men and 12 women) diagnosed with lumbar PVO that was completely cured with no recurrences after antibiotic therapy. They were divided into two groups with (group A, n = 18) and without (group B, n = 14) intervertebral autofusion at six-month follow-up. Differences in back pain, blood inflammatory markers, and radiological features of PVO on simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) of the intervertebral structure between the two groups were analyzed. Results: The mean duration of antibiotic therapy was 41.44 ± 14.21 (21–89) days. Group A showed a statistically higher erythrocyte sedimentation ratio (ESR; 59.28 ± 32.33 vs. 33.93 ± 18.76 mm/h, p = 0.014; normal range of ESR < 25), maximum standardized 18F-FDG uptake (SUVmax; 5.56 ± 1.86 vs. 3.98 ± 1.40, p = 0.013), and sustained extensive edematous changes on T2-weighted fat saturation (T2FS) MRI (p = 0.015) immediately after successful antibiotic therapy. However, no significant differences were observed in back pain, C-reactive protein, or the distribution of 18F-FDG uptake/contrast enhancement on 18F-FDG-PET/MRI (p > 0.05). Conclusions: Higher ESR and SUVmax of the intervertebral structure and sustained extensive edematous change on T2FS MRI immediately after successful antibiotic therapy are related with subsequent intervertebral autofusion, which should be carefully considered when assessing therapeutic response in PVO.

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Clinical and Radiological Analysis of Pyogenic Vertebral Osteomyelitis Immediately after Successful Antimicrobial Therapy: Considerations for Assessing Therapeutic Response

Diagnostics ◽

10.3390/diagnostics10110861 ◽

2020 ◽

Vol 10 (11) ◽

pp. 861

Author(s):

Ikchan Jeon ◽

Eunjung Kong ◽

Dongwoo Yu ◽

Cheol Pyo Hong

Keyword(s):

Back Pain ◽

Clinical Features ◽

Vertebral Body ◽

Antimicrobial Therapy ◽

Fdg Pet ◽

Therapeutic Response ◽

Vertebral Osteomyelitis ◽

Paravertebral Muscle ◽

Radiological Features ◽

Pyogenic Vertebral Osteomyelitis

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.

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Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET

Medicina ◽

10.3390/medicina57080809 ◽

2021 ◽

Vol 57 (8) ◽

pp. 809

Author(s):

Ikchan Jeon ◽

Dongwoo Yu ◽

Eunjung Kong

Keyword(s):

Antibiotic Therapy ◽

Clinical Assessment ◽

Fdg Pet ◽

Therapeutic Response ◽

Clinical Symptoms ◽

Vertebral Osteomyelitis ◽

Parenteral Antibiotic ◽

Reactive Protein ◽

Pyogenic Vertebral Osteomyelitis ◽

18F Fdg

Backgroundand objectives: The clinical assessment of therapeutic response in pyogenic vertebral osteomyelitis (PVO) has been usually performed based on the changes of clinical symptoms and blood inflammatory markers. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has emerged as an alternative independent method. We analyzed the validity of the clinical assessment for detecting residual PVO based on 18F-FDG-PET. Materials and Methods: This study was conducted with 53 patients confirmed as lumbar PVO under retrospective design. All patients underwent clinical assessment using clinical symptoms and C-reactive protein (CRP) for therapeutic response after parenteral antibiotic therapy, which led to the decision of placement in the uncontrolled (group UC) or controlled (group C) group. The validity of clinical assessment was analyzed based on the cut-off values of FDG uptake for detecting residual PVO as references, which are already established in the previous literature. Results: The mean duration of parenteral antibiotic therapy and recurrence rate were 42.19 ± 15.84 (21–89) days and 9.4% (5/53), respectively. 18F-FDG-PETs were performed at 80 rounds of clinical assessment on 37.40 ± 13.15 (21–83) days of parenteral antibiotic therapy and divided: 31 into group UC and 49 into group C, according to the decisions of clinical assessment. Based on the cut-off values of FDG uptake, clinical assessment showed 48.4–58.1% of false positive for residual PVO in group UC. However, 18F-FDG-PET showed 8.2% (4/49) of false negative for residual PVO in group C, which led to recurrences. Conclusions: Clinical assessment using clinical symptoms and CRP for evaluating therapeutic response in PVO is still a useful method in terms of similar recurrence rate compared to 18F-FDG-PET. However, the high rate of false positive for residual PVO can prolong the use of unnecessary antibiotics and overall treatment period.

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Assessment of Therapeutic Response in Pyogenic Vertebral Osteomyelitis Using 18F-FDG-PET/MRI

Diagnostics ◽

10.3390/diagnostics10110916 ◽

2020 ◽

Vol 10 (11) ◽

pp. 916

Author(s):

Ikchan Jeon ◽

Eunjung Kong ◽

Sang Woo Kim ◽

Ihn Ho Cho ◽

Cheol Pyo Hong

Keyword(s):

Fdg Pet ◽

Therapeutic Response ◽

Vertebral Osteomyelitis ◽

Standardized Uptake Value ◽

Clinical Assessments ◽

Fdg Uptake ◽

Reactive Protein ◽

Positron Emission ◽

Pyogenic Vertebral Osteomyelitis ◽

Magnetic Resonance Imaging Mri

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.

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Pulmonary Findings of [18F]FDG PET/CT Images on Asymptomatic COVID-19 Patients

Pathogens ◽

10.3390/pathogens10070839 ◽

2021 ◽

Vol 10 (7) ◽

pp. 839

Author(s):

Tzu-Chuan Ho ◽

Chin-Chuan Chang ◽

Hung-Pin Chan ◽

Ying-Fong Huang ◽

Yi-Ming Arthur Chen ◽

...

Keyword(s):

Systematic Review ◽

Fdg Pet ◽

Standardized Uptake Value ◽

Fdg Uptake ◽

Asymptomatic Patients ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Maximal Standardized Uptake Value ◽

Fdg Pet Ct

During the coronavirus disease 2019 (COVID-19) pandemic, several case studies demonstrated that many asymptomatic patients with COVID-19 underwent fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) examination for various indications. However, there is a lack of literature to characterize the pattern of [18F]FDG PET/CT imaging on asymptomatic COVID-19 patients. Therefore, a systematic review to analyze the pulmonary findings of [18F]FDG PET/CT on asymptomatic COVID-19 patients was conducted. This systematic review was performed under the guidelines of PRISMA. PubMed, Medline, and Web of Science were used to search for articles for this review. Articles with the key words: “asymptomatic”, “COVID-19”, “[18F]FDG PET/CT”, and “nuclear medicine” were searched for from 1 January 2020 to 20 May 2021. Thirty asymptomatic patients with COVID-19 were included in the eighteen articles. These patients had a mean age of 62.25 ± 14.85 years (male: 67.71 ± 12.00; female: 56.79 ± 15.81). [18F]FDG-avid lung lesions were found in 93.33% (28/30) of total patients. The major lesion was [18F]FDG-avid multiple ground-glass opacities (GGOs) in the peripheral or subpleural region in bilateral lungs, followed by the consolidation. The intensity of [18F]FDG uptake in multiple GGOs was 5.605 ± 2.914 (range from 2 to 12) for maximal standardized uptake value (SUVmax). [18F]FDG-avid thoracic lymph nodes (LN) were observed in 40% (12/40) of the patients. They mostly appeared in both mediastinal and hilar regions with an SUVmax of 5.8 ± 2.93 (range from 2.5 to 9.6). The [18F]FDG uptake was observed in multiple GGOs, as well as in the mediastinal and hilar LNs. These are common patterns in PET/CT of asymptomatic patients with COVID-19.

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Coronary, aortic and carotid artery inflammation by 18F-fluorodeoxyglucose positron emission tomography in acute and chronic coronary artery disease

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.344 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

W Nammas ◽

S Uotila ◽

J Teuho ◽

M Pietila ◽

J Airaksinen ◽

...

Keyword(s):

Coronary Arteries ◽

Fdg Pet ◽

Carotid Arteries ◽

Standardized Uptake Value ◽

Chronic Coronary Artery Disease ◽

Fdg Uptake ◽

Positron Emission ◽

Arterial Inflammation ◽

18F Fdg ◽

Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) can detect arterial inflammation in individuals with atherosclerosis, but the associations among different vascular territories for 18F-FDG uptake are not known. Purpose We explored any possible correlation between arterial inflammation quantified by 18F-FDG PET in the aorta, carotid arteries, and coronary arteries in patients presenting with acute coronary syndrome (ACS), or chronic coronary artery disease (CAD). Methods Prospectively, we performed hybrid computed tomography angiography and 18F-FDG PET in 43 patients (26 ACS and 17 chronic CAD) at 6.6 ± 5.7 days following invasive coronary angiography. 18F-FDG PET was performed 90 minutes after injection of 302.2 ± 28.4 MBq 18F-FDG. Arterial 18F-FDG uptake was measured in the thoracic aorta, carotid arteries, and coronary arteries, and expressed as the target-to-background ratio (TBR; the ratio between arterial maximal standardized uptake value normalized to blood pool mean standardized uptake value) in the whole artery, and in the most diseased segment (MDS). Results Mean age was 64.9 ± 9.1 years, 90.7% males. The whole artery 18F-FDG uptake was higher in the aorta than in the carotid arteries (median TBR 2.23, interquartile range [0.36] vs. 1.88 [0.42], p < 0.001); whereas uptake in the coronary arteries was lower than in the aorta or carotid arteries (1.13 [0.23], p < 0.001 both). Similarly, 18F-FDG uptake in the aortic MDS was higher than in the carotid MDS (2.75 [0.62] vs. 2.25 [0.63], p < 0.001); whereas 18F-FDG uptake in the coronary MDS was the lowest (1.40 [0.33], p < 0.001 both). These findings were consistent in both ACS and chronic CAD patients. The whole artery 18F-FDG uptake of the aorta and carotid arteries correlated in patients with ACS (r = 0.58, p = 0.002), but not in patients with chronic CAD (r = 0.21, p = 0.3). There was no correlation between the whole artery 18F-FDG uptake in the coronary arteries and either the aorta or carotid arteries in the whole cohort (r=-0.16, p = 0.2, r = 0.01, p = 0.9, respectively), in patients with ACS (r = 0.06, p = 0.7, r=-0.01, p = 0.9, respectively), or in those with chronic CAD (r=-0.4, p = 0.1, r=-0.09, p = 0.7, respectively). Conclusions In patients with ACS or chronic CAD, large arteries had higher 18F-FDG uptake than the coronary arteries. The intensity of 18F-FDG uptake in the coronary arteries did not correlate with that in the carotid arteries or the aorta, indicating that disease activity differs between large arteries and coronary arteries.

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A Few Cases of Increased FDG Uptake on 18F-FDG PET/CT in Residual Lesions of Tuberculosis at the Time of Treatment Completion

CHEST Journal ◽

10.1378/chest.2279071 ◽

2015 ◽

Vol 148 (4) ◽

pp. 168A

Author(s):

MYUNGSUN LEE ◽

Ina Jung ◽

Youngran Kim ◽

Jiyeon Lee

Keyword(s):

Fdg Pet ◽

Treatment Completion ◽

Fdg Uptake ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Residual Lesions

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Abstract 2352: 18F-fluorodeoxyglucose PET Can Identify The Inflamed and Vulnerable Carotid Plaque - A Prospective Study in Japan

Stroke ◽

10.1161/str.43.suppl_1.a2352 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Satoshi Kuroda ◽

Hisayasu Saito ◽

Katsuhiko Maruichi ◽

Naoki Nakayama ◽

Kenji Hirata ◽

...

Keyword(s):

Carotid Artery ◽

Prospective Study ◽

Carotid Artery Stenosis ◽

Fdg Pet ◽

Vulnerable Plaque ◽

Japanese Patients ◽

Artery Stenosis ◽

Fdg Uptake ◽

Standardized Uptake Values ◽

18F Fdg

Objective - There are few studies that denote the validity of 8F-fluorodeoxyglucose (FDG) PET to detect the inflammation of severe (>70%) carotid artery stenosis in Asian populations. This study was aimed to clarify whether 18F-FDG PET can identify inflamed and vulnerable plaque at higher risk for subsequent ischemic stroke in Japanese patients with severe carotid artery stenosis. Methods - This prospective study included 33 patients with severe carotid artery stenosis between 2006 and 2011. Of these, 12 patients were symptomatic and other 21 were asymptomatic. There were 28 males and 5 females. Their mean age was 71.1 ± 8.2 years, ranging from 48 to 85. Their clinical data were precisely collected. All 33 patients underwent 18F-FDG PET and ultrasound sonography (US) to evaluate the plaque composition prior to carotid endarterectomy (CEA). FDG uptake was quantified by maximum standardized uptake values (SUV). Following surgery, the specimens were stained with the antibodies against CD68 and MMP-9. Results - High FDG uptake (SUV>2.0) was observed in 15 (45%) of 33 operated plaques. High FDG uptake significantly correlated with the other vascular disorders (P=0.048), echolucent plaque (P=0.041), lipid-rich plaque (P<0.001), CD68 expression (P<0.001), and MMP-9 expression (P=0.002). 18F-FDG PET showed significantly higher sensitivity and specificity to identify lipid-rich and CD68-positive plaque than US. However, high FDG uptake was not related to patients’ gender, age, and the degree of stenosis. There was no significant correlation between FDG uptake and symptomatic or asymptomatic patients. Conclusion - These findings strongly suggest that 18F-FDG PET would provide more valuable information to identify the inflamed, vulnerable plaque than conventional ultrasound in Japanese patients with severe carotid artery stenosis.

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Discontinuation of metformin to prevent metformin-induced high colonic FDG uptake: is 48 h sufficient?

Annals of Nuclear Medicine ◽

10.1007/s12149-020-01509-z ◽

2020 ◽

Vol 34 (11) ◽

pp. 833-839

Author(s):

Nanno Schreuder ◽

Hedwig Klarenbeek ◽

Brian N. Vendel ◽

Pieter L. Jager ◽

Jos G. W. Kosterink ◽

...

Keyword(s):

Fdg Pet ◽

Control Group ◽

Diabetic Patients ◽

Fdg Uptake ◽

Pet Ct ◽

Group A ◽

Clinically Significant ◽

Fdg Pet Ct ◽

Colon Ascendens

Abstract Objective In this retrospective, single-center observational study, we investigated whether discontinuing metformin for at least 48 h prevents metformin-induced [18F]fluorodeoxyglucose (FDG) uptake in all segments of the colon. Methods Patients with type 2 diabetes who were using metformin before undergoing an FDG PET/CT scan were included. Two groups were created: patients who discontinued metformin for less than 48 h (< 48 h group) and patients who discontinued metformin for between 48 and 72 h (≥ 48 h group). A control group comprised non-diabetic patients who were not using metformin before undergoing an FDG PET/CT. We visually scored the uptake of FDG in four segments of the colon—the ascendens, transversum, descendens, and rectosigmoid—using a four-point scale (1–4) and considered scores of 3 or 4 to be clinically significant. Results Colonic FDG uptake in the ≥ 48 h group (n = 23) was higher than uptake in the control group (n = 96) in the colon descendens [odds ratio (OR) 14.0; 95% confidence interval (CI) 4.8–40.9; p value: 0.001] and rectosigmoid (OR 11.3; 95% CI 4.0–31.9; p value: 0.001), and there was no difference in the colon ascendens and transversum. Colonic FDG uptake in the < 48 h group (n = 25) was higher than uptake in the ≥ 48 h group (n = 23) in the colon transversum (OR 4.8; 95% CI 1.3–18.5; p value: 0.022) and rectosigmoid (p value: 0.023), and there was no difference in the colon ascendens and descendens. Conclusions Discontinuing metformin for 48 h before undergoing an FDG PET/CT still gives a high uptake in the distal parts of the colon when compared with non-diabetic patients who are not using metformin. Discontinuing metformin for 48 h seems to be useful for scanning the more proximal segments of the colon.

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Benign High-Flow Priapism With a Diffuse and Intense 18F-FDG Uptake on 18F-FDG PET/CT Scanning

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000002616 ◽

2019 ◽

Vol 44 (7) ◽

pp. e442-e444

Author(s):

Zakieh Nasiri ◽

Soroush Zarehparvar Moghadam ◽

Zahra Kiamanesh ◽

Farshad Emami ◽

Ramin Sadeghi

Keyword(s):

Fdg Pet ◽

Ct Scanning ◽

High Flow ◽

Fdg Uptake ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

BMC Infectious Diseases ◽

10.1186/s12879-020-05669-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Therapeutic Response ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Bacterial Identification ◽

Oral Antibiotics ◽

Normal Range ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

Abstract Background There are still controversies regarding the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO. Methods A retrospective study was performed with non-surgical lumbar PVO patients. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative PVO and CP group with culture-positive PVO). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups. Results Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. The CN group showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) but a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, the mean erythrocyte segmentation rate (ESR, normal range: < 25 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL) level, and visual analog scale (VAS) score of back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p = 1.000). The presence of epidural abscess was the most significant factor for the identification of causative bacteria (p = 0.002), and there was no significant relationship between the use of empirical antibiotics before tissue culture and the causative bacterial identification (p = 0.194). Conclusions The CN group required a shorter duration of parenteral antibiotics than the CP group. Discontinuation of parenteral antibiotics or changing the administration route can be considered based on the values of ESR, CRP, and VAS score of back pain. The presence of epidural abscess was the most significant factor for the identification of causative bacteria.

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