Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Pyogenic and Tuberculous Spondylitis: Preliminary Study

Objective: The purpose of this study was to compare the effectiveness of positron emission tomography (PET)/computed tomography (CT) in distinguishing between tuberculous and pyogenic spondylitis with that of magnetic resonance imaging (MRI). Methods: Twenty-two consecutive patients confirmed to have tuberculous or pyogenic spondylitis were examined with both MRI and dual-time point PET/CT. The serum C-reactive protein (CRP) level was measured. The early and delayed PET/CT data were analyzed using the standardized uptake value (SUV). The radiologists scored the MRI findings and differentiated between tuberculous and pyogenic spondylitis. Each MRI result and CRP value was compared with the SUVs of PET/CT. Results: The reviewers identified tuberculous spondylitis (n = 11) on MRI, with a sensitivity, specificity, and positive predictive values of 90%, 100%, and 100%, respectively. For pyogenic spondylitis (n = 11), the corresponding values were 100%, 90%, and 92%, respectively. There was a significant difference in the maximum SUVs of the early phase between tuberculous and pyogenic spondylitis (P = 0.028). Magnetic resonance imaging was superior to PET/CT in differentiating between tuberculous and pyogenic spondylitis (P = 0.043). A comparison of the maximum SUVs of the early phase and CRP values revealed a correlation coefficient of 0.581 (P = 0.006). Conclusions: The maximum SUVs of early-phase PET/CT may be complementary to MRI for differentiating pyogenic and tuberculous spondylitis and reflecting the activity of infectious spondylitis.