Nuklearmedizinische Verfahren zur Diagnostik der Spondylodiszitis

Zusammenfassung

Es existieren zahlreiche nuklearmedizinische Verfahren zur Detektion einer Spondylodiszitis (SP), welche sich in ihrer diagnostischen Wertigkeit teils deutlich unterscheiden. Während sich die Leukozyten- beziehungsweise Antikörperszintigrafie aufgrund mangelnder Sensitivität und Spezifität nicht bewährt hat, zeigt die Skelettszintigrafie gute Ergebnisse und kommt insbesondere bei Kontraindikationen zur MRT zum Einsatz. Die ¹⁸F-FDG-PET hat sich inzwischen als führende Diagnostik der SP in der nuklearmedizinischen Bildgebung durchgesetzt. Insbesondere im Vergleich zur MRT, welche bis dato den Gold-Standard der morphologisch-diagnostischen Bildgebung der SP darstellt, liefert die ¹⁸F-FDG-PET deutliche Vorteile. So zeigt sich die ¹⁸F-FDG-PET bezüglich der Differenzierung zwischen degenerativen und entzündlichen Veränderungen, der frühen Detektion der Erkrankung sowie der Evaluation des Therapieansprechens überlegen. Insgesamt liefert die Kombination aus ¹⁸F-FDG-PET und MRT eine nahezu 100 %ig korrekte Detektion infektiöser SP.

Abstract

Numerous nuclear imaging techniques exist for detection of spondylodiscitis (SP), which vary in terms of their diagnostic value. While leucocyte and antigranulocyte antibody scintigraphy show lack of sensitivity and specificity, bone scintigraphy provides satisfactory results and is used particularly when MRI is contraindicated. Today, ¹⁸F-FDG-PET is the leading method of nuclear imaging in the diagnosis of SP. MRI may be the gold standard in imaging, however ¹⁸F-FDG-PET provides many advantages. It proves to be superior regarding the differentiation between degenerative and infectious disease, early detection of SP as well as the evaluation of early therapy response. ¹⁸F-FDG-PET together with MRI show a nearly 100 % correct detection of infectious SP.

Schlüsselwörter

Spondylodiszitis - spinale Infektion - Skelettszintigrafie - ¹⁸F-FDG-PET - MRT

Keywords

spondylodiscitis - spinal infection - bone scan - ¹⁸F-FDG-PET - MRI

• Literatur

• 1 Sobottke R, Seifert H, Fätkenheuer G. et al. Current Diagnosis and Treatment of Spondylodiscitis. Dtsch Arztebl Int 2008; 105: 181-187
• 2 Treglia G, Focacci C, Caldarella C. et al. The role of nuclear medicine in the diagnosis of spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16: 20-25
• 3 Whalen JL, Brown ML, McLeod R. et al. Limitations of indium leukocyte imaging for the diagnosis of spine infections. Spine (Phila Pa 1976) 1991; 16: 193-197
• 4 Palestro CJ, Kim CK, Swyer AJ. et al. Radionuclide diagnosis of vertebral osteomyelitis: indium-111-leukocyte and technetium-99m-methylene diphosphonate bone scintigraphy. J Nucl Med 1991; 32: 1861-1865
• 5 Roelants V, Tang T, Ide C. et al. Cold vertebra on (111)In-white blood cell scintigraphy. Semin Nucl Med 2002; 32: 236-237
• 6 Rüther W, Hotze A, Möller F. et al. Diagnosis of bone and joint infection by leucocyte scintigraphy. A comparative study with 99mTc-HMPAO-labelled leucocytes, 99mTc-labelled antigranulocyte antibodies and 99mTc-labelled nanocolloid. Arch Orthop Trauma Surg 1990; 110: 26-32
• 7 Schicha H, Schober O. Nuklearmedizin. Basiswissen und klinische Anwendung. 7.. Auflage Stuttgart: Schattauer; 2013
• 8 Modic MT, Feiglin DH, Piraino DW. et al. Vertebral osteomyelitis: assessment using MR. Radiology 1985; 157: 157-166
• 9 Gratz S, Dörner J, Oestmann JW. et al. 67Ga-citrate and 99Tcm-MDP for estimating the severity of vertebral osteomyelitis. Nucl Med Commun 2000; 21: 111-120
• 10 Love C, Patel M, Lonner BS. et al. Diagnosing spinal osteomyelitis: a comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. Clin Nucl Med 2000; 25: 963-977
• 11 Sudhakar P, Sharma AR, Bhushan SM. et al. Efficacy of SPECT over planar bone scan in the diagnosis of solitary vertebral lesions in patients with low back pain. Indian J Nucl Med 2010; 25: 44-48
• 12 Kumar V, Boddeti DK. (68)Ga-radiopharmaceuticals for PET imaging of infection and inflammation. Recent Results Cancer Res 2013; 194: 189-219
• 13 Nanni C, Errani C, Boriani L. et al. 68Ga-citrate PET/CT for evaluating patients with infections of the bone: preliminary results. J Nucl Med 2010; 51: 1932-1936
• 14 Gratz S, Dörner J, Fischer U. et al. 18F-FDG hybrid PET in patients with suspected spondylitis. Eur J Nucl Med Mol Imaging 2002; 29: 516-524
• 15 Fischer DR, Pfirrmann CW, Zubler V. et al. High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI. EJNMMI Res 2012; 2: 38
• 16 Freesmeyer M, Stecker FF, Schierz JH. et al. First experience with early dynamic (18)F-NaF-PET/CT in patients with chronic osteomyelitis. Ann Nucl Med 2014; 28: 314-321
• 17 Prodromou ML, Ziakas PD, Poulou LS. et al. FDG PET is a robust tool for the diagnosis of spondylodiscitis: a meta-analysis of diagnostic data. Clin Nucl Med 2014; 39: 330-335
• 18 Hungenbach S, Delank KS, Dietlein M. et al. 18F-fluorodeoxyglucose uptake pattern in patients with suspected spondylodiscitis. Nucl Med Commun 2013; 34: 1068-1074
• 19 Seifen T, Rettenbacher L, Thaler C. et al. Prolonged back pain attributed to suspected spondylodiscitis. The value of ¹⁸F-FDG PET/CT imaging in the diagnostic work-up of patients. Nuklearmedizin 2012; 51: 194-200
• 20 Fuster D, Tomás X, Mayoral M. et al. Prospective comparison of whole-body (18)F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 2015; 42: 264-271
• 21 Varma R, Lander P, Assaf A. Imaging of pyogenic infectious spondylodiskitis. Radiol Clin North Am 2001; 39: 203-213
• 22 Diehn FE. Imaging of spine infection. Radiol Clin North Am 2012; 50: 777-798
• 23 Albert HB, Kjaer P, Jensen TS. et al. Modic changes, possible causes and relation to low back pain. Med Hypotheses 2008; 70: 361-368
• 24 Skanjeti A, Penna D, Douroukas A. et al. PET in the clinical work-up of patients with spondylodiscitis: a new tool for the clinician?. Q J Nucl Med Mol Imaging 2012; 56: 569-576
• 25 Stumpe KD, Zanetti M, Weishaupt D. et al. FDG positron emission tomography for differentiation of degenerative and infectious endplate abnormalities in the lumbar spine detected on MR imaging. AJR Am J Roentgenol 2002; 179: 1151-1157
• 26 Smids C, Kouijzer IJ, Vos FJ. et al. A comparison of the diagnostic value of MRI and 18F-FDG-PET/CT in suspected spondylodiscitis. Infection 2017; 45: 41-49
• 27 Niccoli Asabella A, Iuele F, Simone F. et al. Role of (18)F-FDG PET/CT in the evaluation of response to antibiotic therapy in patients affected by infectious spondylodiscitis. Hell J Nucl Med 2015; 18: 17-22
• 28 Nanni C, Boriani L, Salvadori C. et al. FDG PET/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 2012; 39: 1538-1544
• 29 Nakahara M, Ito M, Hattori N. et al. 18F-FDG-PET/CT better localizes active spinal infection than MRI for successful minimally invasive surgery. Acta Radiol 2015; 56: 829-836
• 30 Fahnert J, Purz S, Jarvers JS. et al. Use of Simultaneous 18F-FDG PET/MRI for the Detection of Spondylodiskitis. J Nucl Med 2016; 57: 1396-1401