Clinical impact of (18)F-FDG PET/CT on the management and diagnosis of infectious spondylitis.

OBJECTIVE: The aim of this study was to evaluate the impact of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) on the management of patients with infectious spondylitis. MATERIALS AND METHODS: Twenty-nine patients with infectious spondylitis (9 with tuberculous spondylitis and 20 with pyogenic spondylitis) who had undergone an (18)F-FDG PET/CT examination were retrospectively evaluated; 42 lesions were detected. A useful impact on the clinical management of infection therapy (start or longer duration of antibiotic therapy, or surgical intervention, etc) was defined as a strong impact, whereas gaining new information not affecting the clinical management of infection therapy from (18)F-FDG PET/CT was defined as a weak impact. No impact was defined as not obtaining any new information influencing infection therapy. RESULTS: (18)F-FDG PET/CT had a strong impact on the clinical management of 52% (15 of 29) of the patients. (18)F-FDG PET/CT detected 10 cases of spondylitis and one artificial graft infection that the clinician had not recognized, and the therapeutic period was extended in these patients. In five patients with tuberculous spondylitis, the (18)F-FDG PET/CT images were used to decide the biopsy sites in three patients and to determine which lesions required surgery in two patients. CONCLUSION: (18)F-FDG PET/CT is useful for detecting infectious spondylitis.

Constrictive tuberculous pericarditis diagnosed using 18F-fluorodeoxyglucose positron emission tomography: a report of two cases.

We present two cases of tuberculous pericarditis that were diagnosed using 18F-fluorodeoxyglycose (18F-FDG) positron emission tomography (PET). Here, we highlight the value of 18F-FDG-PET for demonstrating tuberculous pericardial involvement as well as disease dissemination and activity. The patients received antitubercular treatment, and their symptoms and findings resolved accordingly.

Cold tuberculous abscess identified by FDG PET.

We report FDG PET of two cases of cold abscess due to Mycobacterium tuberculosis. Case 1 had colon cancer; FDG PET showed high FDG uptake in the colon lesion and low uptake in the inguinal lesion. The latter was a tuberculous cold abscess confirmed by CT/MRI and biopsy. Case 2 received radiotherapy for lung cancer and presented with suspected vertebral metastasis. Further studies revealed tuberculosis of the vertebra and a tuberculous cold abscess in the iliopsoas muscle. FDG PET showed moderate uptake in the third lumbar spine and low uptake in the abscess center of iliopsoas lesion. Both tuberculous cold abscesses showed moderate FDG uptake in the capsule and low uptake in the center. These features are unique compared with non-tuberculous abscess and typical tuberculosis lesions, which are characterized by high FDG uptake. Pathologically, tuberculous cold abscess is not accompanied by active inflammatory reaction. Our findings suggested that the FDG uptake by tuberculous lesion varies according to the grade of inflammatory activity. The new diagnostic features of tuberculous cold abscess may be useful in the evaluation of such lesions by FDG PET.

Granular cell tumor presenting as an intradural extramedullary tumor.

Granular cell tumor (GCT) is an uncommon benign tumor, which is thought to originate from a Schwann cell. GCT may involve any part of the body, but in our knowledge, there has been only one previous report of GCT, which arose in the intradural extramedullary space of the spine. We report a case of GCT, which occurred in the intradural extramedullary space.

[A case of multiple bone and joint tuberculosis which had been misdiagnosed as the rheumatoid arthritis and treated with prednisolone for eleven months].

A 34-year-old man had a multiple arthralgia for about eleven months. The swelling of his right wrist and foot had appeared in the dorsal side, and he had been misdiagnosed as the rheumatoid arthritis. He was treated with prednisolone in the dosages of 2.5 mg per day for one month, and 10 mg per day for ten months. When he admitted to our hospital, the bone X-ray examinations of the wrist and foot revealed the marked atrophy and destruction of the carpal and tarsal bones. The aspiration fluid from the swelling around his wrist and foot was positive for acid-fast bacilli on smear and Mycobacterium tuberculosis was found on culture. He was treated with isoniazid, rifampicin, ethambutol and pyrazinamide, however, these medication was not adequately effective to his complications of tuberculous arthritis. Curettage, irrigation and synovectomy of his right carpal and tarsal bone were performed in order to control his bone and joint infection. He recovered from his arthritis and tenosynovitis after these operations. The clinical practitioners should not omit tuberculosis from the differential diagnosis of persistent osteoarthralgia.