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

Giorgio Treglia; Mariarosa Pascale; Elena Lazzeri; Wouter van der Bruggen; Roberto C Delgado Bolton; Andor W J M Glaudemans

doi:10.1007/s00259-019-04571-6

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. 2020 May;47(5):1287-1301. doi: 10.1007/s00259-019-04571-6. Epub 2019 Nov 15.

Authors

Giorgio Treglia^{1

2

3}, Mariarosa Pascale⁴, Elena Lazzeri⁵, Wouter van der Bruggen⁶, Roberto C Delgado Bolton⁷, Andor W J M Glaudemans⁸

Affiliations

¹ Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona and Lugano, Switzerland. giorgio.treglia@eoc.ch.
² Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. giorgio.treglia@eoc.ch.
³ Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Via Lugano 4F, CH-6500, Bellinzona, Switzerland. giorgio.treglia@eoc.ch.
⁴ Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
⁵ Regional Center of Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
⁶ Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands.
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.
⁸ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

PMID: 31729539
DOI: 10.1007/s00259-019-04571-6

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.

Keywords: PET/CT; diagnosis; meta-analysis; spinal infection; systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Fluorodeoxyglucose F18*
Humans
Positron Emission Tomography Computed Tomography*
Prospective Studies
Radiopharmaceuticals
Sensitivity and Specificity

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18