Abstract
Background
Evaluation of the child with spinal fusion hardware and concern for infection is challenging because of hardware artifact with standard imaging (CT and MRI) and difficult physical examination. Studies using 18F-FDG PET/CT combine the benefit of functional imaging with anatomical localization.
Objective
To discuss a case series of children and young adults with spinal fusion hardware and clinical concern for hardware infection. These people underwent FDG PET/CT imaging to determine the site of infection.
Materials and methods
We performed a retrospective review of whole-body FDG PET/CT scans at a tertiary children’s hospital from December 2009 to January 2012 in children and young adults with spinal hardware and suspected hardware infection. The PET/CT scan findings were correlated with pertinent clinical information including laboratory values of inflammatory markers, postoperative notes and pathology results to evaluate the diagnostic accuracy of FDG PET/CT. An exempt status for this retrospective review was approved by the Institution Review Board.
Results
Twenty-five FDG PET/CT scans were performed in 20 patients. Spinal fusion hardware infection was confirmed surgically and pathologically in six patients. The most common FDG PET/CT finding in patients with hardware infection was increased FDG uptake in the soft tissue and bone immediately adjacent to the posterior spinal fusion rods at multiple contiguous vertebral levels. Noninfectious hardware complications were diagnosed in ten patients and proved surgically in four. Alternative sources of infection were diagnosed by FDG PET/CT in seven patients (five with pneumonia, one with pyonephrosis and one with superficial wound infections).
Conclusion
FDG PET/CT is helpful in evaluation of children and young adults with concern for spinal hardware infection. Noninfectious hardware complications and alternative sources of infection, including pneumonia and pyonephrosis, can be diagnosed. FDG PET/CT should be the first-line cross-sectional imaging study in patients with suspected spinal hardware infection. Because pneumonia was diagnosed as often as spinal hardware infection, initial chest radiography should also be performed.
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Acknowledgement
This work was presented at the 2012 Society for Pediatric Radiology national meeting April 2012, San Francisco, CA (abstract PA-001).
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Bagrosky, B.M., Hayes, K.L., Koo, P.J. et al. 18F-FDG PET/CT evaluation of children and young adults with suspected spinal fusion hardware infection. Pediatr Radiol 43, 991–1000 (2013). https://doi.org/10.1007/s00247-013-2654-9
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DOI: https://doi.org/10.1007/s00247-013-2654-9