The Diagnostic Value of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for the Detection of Surgical Site Infection after Spine Surgery

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2021-05, Vol.46 (10), p.E602-E610
• Main Authors: Segawa, Tomohide, Koga, Hisashi, Oshina, Masahito, Fukushima, Masayoshi, Inanami, Hirohiko
• Format: Article
• Language: English
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0000000000003847

STUDY DESIGN.Retrospective case series. OBJECTIVE.The purpose of this study was to assess the diagnostic yield of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for surgical site infection (SSI) after spine surgery. SUMMARY OF BACKGROUND DATA.Diagnosis of SSI in the spine based on F-18 FDG PET/CT requires experienced nuclear medical physicians for a detailed analysis of F-18 FDG distribution pattern. It has also been reported that increases in the maximal standardized uptake values of F-18 FDG (SUVmax) closely correlated with SSI, suggesting potential of more objective and quantitative diagnosis. METHODS.We assessed the diagnostic yield of F-18 FDG PET/CT (pattern-based diagnosis by nuclear medical physicians and SUVmax-based diagnosis) for SSI in 52 subjects who underwent spine surgery. The 52 subjects included 11 non-implant and 41 implant cases. F-18 FDG PET/CT was performed in 33 and 19 cases in early (≤12 weeks after the surgery) and late (>12 weeks) phases, respectively. The final diagnosis of SSI was based on the results of pathogen identification, plain radiography, and CT and/or MRI or response to antibiotics and/or reoperation. RESULTS.SUVmax-based diagnosis was performed with a cut off value of 5.0 as determined by receiver operating characteristic analysis. Both pattern-based and SUVmax-based diagnoses demonstrated excellent diagnostic yields with high sensitivity (97% and 90%), specificity (100% and 100%), and accuracy (98% and 94%). High diagnostic yields (accuracy of ≥90%) were consistently observed irrespective of presence or absence of implantation or interval between surgery and F-18 FDG PET/CT. CONCLUSION.F-18 FDG PET/CT can be the procedure of choice for investigation of SSI in the spine when other imaging fails to provide a definitive diagnosis.Level of Evidence4