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1、1Cases Report p.8 2o/10 5210B5110518F-FDG-PET/CT findings in patients affected by spondylodiscitisFrancesco Bertagna1, MDClaudio Pizzocaro1, MDGiorgio Biasiotto2, BScRaffaele Giubbini3, MDThomas Werner4, MDAbass Alavi4, MD, PhD, BSc.1. Nuclear Medicine, Spedali Civili di Brescia, Brescia, Italy.2. B
2、iomedical Technology Department, University of Brescia, Brescia, Italy.3. Chair of Nuclear Medicine, University of Brescia, Brescia, Italy.4. Division of Nuclear Medicine, University of Pennsylvania Medical Center, Philadelphia, USA. * Keywords: -PET/CT image-Spondylodiscitis - Differential diagnosi
3、sCorrespondence address:Francesco Bertagna, MDDepartment of Nuclear MedicineSpedali Civili di BresciaP.le Spedali Civili, 125123 Brescia, Italy, e-mail: francesco.bertagnaspedalicivili.brescia.itTel.: +39-30-3995468Fax: +39-30-3995420Received: 24 March 2010 Accepted revised: 1 June 2010AbstractSpond
4、ylodiscitis (SPD) is an inflammatory process of the intervertebral disc space. We report two cases of patients affected by SPD evaluated by fluorine-18 fluorodesoxyglycose positron emission tomography/computed tomography, which was useful in detecting SPD and supporting differential diagnosis.Introd
5、uction Spondylodiscitis (SPD) is an inflammatory process of the intervertebral disc that can lead to sepsis, septic discitis and ankylosing spondylitis (AS). Its incidence increases with age and infection could be haematogenous after a primary infection elsewhere in the body or infection may be inoc
6、ulated into the intervertebral disc during invasive spinal procedures. A single species of bacteria or, less frequently, polybacterial infections are involved. Most common are Gram-negative bacilli, such as escherichia coli, proteus mirabilis, enterococcus, pseudomonas aeruginosa and Brucella 1. Bac
7、illus Koch, non-tuberculous mycobacterium as mycobacterium Xenopi 2 or fungal pathogens like candida albicans and aspergillus can also be isolated from immunosuppressed patients. Clinical presentation is characterised by pain, fever in about one-third of cases, weight loss, anorexia and occasionally
8、 neurological deficit. A rise in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) is usually seen, while leucocytosis is occasionally present 3. Computerized tomography (CT) yields positive findings in the early stages of SPD and can also be used to guide disc biopsy or drainage of
9、a paravertebral collection. The most accurate method, which provides better definition of the epidural and paravertebral spaces and also allows assessment of compression of neural elements is magnetic resonance imaging (MRI). Despite the documented utility and accuracy of these techniques, CT and MR
10、I could be less reliable when post-surgical changes, scarring or implants are present. Radionuclide scans with gallium-67 citrate (67Ga-C), bone schintigraphy, technetium-99m/ciprofloxacin or radiolabelled antifungal tracers are sensitive to abnormal metabolic activity and the last two are also spec
11、ific. The definitive diagnosis of SPD is made by the isolation of pathogens from intra-operative cultures, the spinal implant or the bone lesion, by histopathological analysis, or blood cultures 4. Antibiotic treatment is mandatory. Most authors favour immobilization which may take the form of bed r
12、est or a brace 3, 5. Surgery may be indicated for the resolution of significant spinal cord or radicular compression, for prevention or correction of biomechanical instability and deformity, for the management of severe persistent pain, or for drainage of abscesses. Surgery may also be necessary whe
13、n the principal aim is debridement of infected tissues, protecting an adequate blood supply for tissue healing and maintainance or restoration of spinal stability 3, 5. Patients should be followed up by clinical assessment of pain and neurological features, laboratory assessment with serial monitori
14、ng of CRP and ESR, and radiological examination by plain radiographs throughout treatment and for one year after its completion in order to detect relapses 3, 5. A follow-up MRI or CT is usually unnecessary if clinical and laboratory parameters indicate a favourable response like reduction of back p
15、ain and recovery of constitutional symptoms 3, 5. It is sometimes difficult to correctly diagnose and treat SPD. Case descriptionWe have diagnosed two patients with SPD. They were evaluated by 18F-FDG/PET/CT that was performed in the fasting state for at least 6h and with glucose level lower than 150mg/dL. An 18F-FDG dose of 5.5MBq/kg was administered intravenously and a 2D mode ordered-subset-expectation-maximization (OS-EM) imaging (with septa) was acquired 60min after injection on a Discovery ST PET/CT tomography (General Ele
