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Master Thesis

Évaluation de l’intérêt de la tomographie par émission de positons au 18F-FDG dans le diagnostic des infections de matériels rachidiens

Abstract : Background: post-operative instrumented spine infection (PISI) is an infrequent complication. Diagnosis of spinal implant infection can be difficult, especially in case of chronic infection. Methods: this retrospective study attempts to evaluate the diagnostic performance of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in PISI. Imagings were performed between April 2010 and June 2018 among patients referred for suspected spinal implant infection. PET/CT were performed more than 12 weeks after surgery. PET/CT images were re-interpreted independently by two nuclear medicine physicians without knowledge of the patient’s conditions. PET/CT data were analyzed both visually and semi-quantitatively (SUVmax). The final diagnosis of infection was based on bacteriological cultures during a twelve-month follow-up. Results: forty-nine PET/CT were performed in 44 patients (22 men, 22 women, median age 63.6 years) with a suspected spinal implant infection. Twenty-two patients had a diagnosis of infection during follow-up. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PET/CT were 86.4%, 81.5%, 79.2%, and 88.0%. Sensitivity specificity, PPV and NPV were 66.7%, 75.0%, 66.0%, 75.0% respectively for MRI and 80%, 92.6%, 84.6% and 69.4% for serum C-reactive protein (CRP) with a 60 mg/L threshold. Although these values were higher for PET/CT than for MRI or CRP, the differences were not statistically significant. In this setting, false positives with PET/CT can be observed in case of previous spine infection or adjacent segments disc disease. False negatives can result of very extensive arthrodesis or infection with low virulence bacteria. Conclusion: PET/CT is useful for the diagnosis of PISI. These promising results should be evaluated in further prospective multicentric study.
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Master Thesis
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Submitted on : Monday, April 1, 2019 - 3:35:13 PM
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Émilie Follenfant. Évaluation de l’intérêt de la tomographie par émission de positons au 18F-FDG dans le diagnostic des infections de matériels rachidiens. Médecine humaine et pathologie. 2018. ⟨dumas-02086752⟩



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