Integrated Imaging (SPECT/CT; PET/CT; MRI) in Infection/Inflammation Spine Pathology

Closed for proposals

Project Type

Coordinated Research Project

Project Code




Approved Date

13 September 2013


4 - Closed

Start Date

13 September 2013

Expected End Date

31 January 2018

Completed Date

3 May 2019

Participating Countries

South Africa
United Kingdom of Great Britain and Northern Ireland


Summary of the Background/Research Problem • The prevalence of back pain has increased worldwide.• Low back pain is now the 6th most common cause for global disability-adjusted life years. • There is likely an increase in spinal surgery in the future. • The most serious complication after spinal surgery is spinal infection.• There remains uncertainty about the imaging modality of choice in the diagnosis of post-operative spinal infection.• There is therefore a clear need for research on imaging modality of choice in the diagnosis of post-operative spinal infection.• There has been a worldwide increase in hybrid imaging (SPECT/CT, PET/CT) and MRI.• Taken into account the above mentioned points, with and increasing prevalence of back pain in low-middle income countries,    is likely going to translate -in the near future- into an increased incidence of spinal surgery, and the associated complications    of it, of which infection at the surgical site is the most serious one. Therefore, a CRP to determine the imaging modality of    choice for the diagnosis and assessment of post-operative spinal infection would be extremely beneficial to further improve    health care delivery in member states.  


To assess the role of multimodality imaging (MRI, 99mTc-UBI SPECT/CT, [18F]FDG PET/CT) in the diagnosis of spinal infection after spinal surgery.

Specific objectives

2 To determine if a specific imaging algorithm can be identified for the evaluation of spinal infection after spinal surgery.

1. To determine and compare the diagnostic performance of MRI, 99mTc-UBI SPECT/CT and [18F]FDG PET/CT in the evaluation of suspected infection of the spine after surgery.


This CRP have :
• Increase knowledge of the medical community about the use of imaging in the diagnosis and assessment of post-operative spinal infection.
• Strengthen Radiology and Nuclear Medicine practice for the evaluation of suspected spinal infection in the participating centres.
• Demonstrate that the diagnostic performance of [18F] FDG PET/CT was similar to that of MRI and should lead to a wider use of this metabolic imaging modality, especially in diabetic patients suspected of osteomyelitis.
• Proposed a diagnostic imaging algorithm for postoperative spinal infection.


Although 99mTc-UBI SPECT/CT was found to be disappointing and the most accurate imaging modality between MRI and [18F]FDG PET/CT remains uncertain, this CRP confirmed the importance of early diagnosis of post-operative spinal infections and the critical role played by imaging techniques.


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