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Diagnostic performance of 18F-FDG PET/CT in patients with spinal infection: a systematic review and a bivariate meta-analysis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Diagnosis of spinal infection (SI) is challenging and usually requires multiple tests. We aimed to perform a systematic review and a bivariate meta-analysis on the diagnostic role of 18F-FDG PET/CT in patients with SI.

Methods

A comprehensive literature search of studies published through February 2019 in PubMed/MEDLINE and Cochrane library databases was carried out. Studies investigating the diagnostic performance of 18F-FDG PET/CT in patients with SI were eligible for inclusion in the qualitative analysis. For the quantitative analysis, pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR−) and diagnostic odds ratio (DOR) of 18F-FDG PET/CT in patients with suspected SI were calculated on a per examination-based analysis. Pooled data were presented with 95% confidence intervals (95% CI).

Results

Twenty-six articles (833 patients) using 18F-FDG PET/CT were eligible for the qualitative analysis. Twelve studies (396 patients) were selected for the meta-analysis. Overall, 18F-FDG PET/CT demonstrated a very good diagnostic performance in patients with SI and several studies underlined the value of 18F-FDG PET/CT in assessing the response to treatment. The bivariate meta-analysis on 18F-FDG PET/CT in patients with suspected SI provided the following results: sensitivity 94.8% (95% CI 88.9–97.6%) and specificity 91.4% (95% CI 78.2–96.9%). The pooled LR+, LR− and DOR were 4.7 (95% CI 2.9–7.7), 0.11 (95% CI 0.07–0.16) and 63.4 (95% CI 28.9–139), respectively. No significant heterogeneity or publication bias was found.

Conclusion

18F-FDG PET/CT demonstrated a very good diagnostic performance in patients with SI and can be used in patients in which MRI cannot be performed or is non-diagnostic or inconclusive. Several studies underlined the value of 18F-FDG PET/CT in assessing the response to treatment in patients with SI. Overall, larger multicentre and prospective studies and cost-effectiveness analyses are warranted.

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Acknowledgements

This work was carried out in collaboration with the Clinical Trial Unit of Ente Ospedaliero Cantonale [CTU-EOC] (Ticino, Switzerland). We are grateful to the staff of the Clinical Trial Unit of Ente Ospedaliero Cantonale for their invaluable statistical support.

Funding

This systematic review and meta-analysis was funded by the European Association of Nuclear Medicine (EANM).

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Authors and Affiliations

  1. Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona and Lugano, Switzerland

    Giorgio Treglia

  2. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

    Giorgio Treglia

  3. Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Via Lugano 4F, CH-6500, Bellinzona, Switzerland

    Giorgio Treglia

  4. Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Mariarosa Pascale

  5. Regional Center of Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

    Elena Lazzeri

  6. Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands

    Wouter van der Bruggen

  7. Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro University Hospital and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain

    Roberto C. Delgado Bolton

  8. Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Andor W. J. M. Glaudemans

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  1. Giorgio Treglia
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Correspondence to Giorgio Treglia.

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Treglia, G., Pascale, M., Lazzeri, E. et al. Diagnostic performance of 18F-FDG PET/CT in patients with spinal infection: a systematic review and a bivariate meta-analysis. Eur J Nucl Med Mol Imaging 47, 1287–1301 (2020). https://doi.org/10.1007/s00259-019-04571-6

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