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Article

Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET

1
Department of Neurosurgery, Yeungnam University College of Medicine, Daegu 42415, Korea
2
Department of Nuclear Medicine, Yeungnam University College of Medicine, Daegu 42415, Korea
*
Author to whom correspondence should be addressed.
Academic Editors: Domenico Albano and Francesco Bertagna
Received: 23 June 2021 / Revised: 4 August 2021 / Accepted: 4 August 2021 / Published: 6 August 2021
(This article belongs to the Special Issue 2-[18F]-FDG PET/CT in Oncology: New Evidences and Future Perspectives)
Backgroundand objectives: The clinical assessment of therapeutic response in pyogenic vertebral osteomyelitis (PVO) has been usually performed based on the changes of clinical symptoms and blood inflammatory markers. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has emerged as an alternative independent method. We analyzed the validity of the clinical assessment for detecting residual PVO based on 18F-FDG-PET. Materials and Methods: This study was conducted with 53 patients confirmed as lumbar PVO under retrospective design. All patients underwent clinical assessment using clinical symptoms and C-reactive protein (CRP) for therapeutic response after parenteral antibiotic therapy, which led to the decision of placement in the uncontrolled (group UC) or controlled (group C) group. The validity of clinical assessment was analyzed based on the cut-off values of FDG uptake for detecting residual PVO as references, which are already established in the previous literature. Results: The mean duration of parenteral antibiotic therapy and recurrence rate were 42.19 ± 15.84 (21–89) days and 9.4% (5/53), respectively. 18F-FDG-PETs were performed at 80 rounds of clinical assessment on 37.40 ± 13.15 (21–83) days of parenteral antibiotic therapy and divided: 31 into group UC and 49 into group C, according to the decisions of clinical assessment. Based on the cut-off values of FDG uptake, clinical assessment showed 48.4–58.1% of false positive for residual PVO in group UC. However, 18F-FDG-PET showed 8.2% (4/49) of false negative for residual PVO in group C, which led to recurrences. Conclusions: Clinical assessment using clinical symptoms and CRP for evaluating therapeutic response in PVO is still a useful method in terms of similar recurrence rate compared to 18F-FDG-PET. However, the high rate of false positive for residual PVO can prolong the use of unnecessary antibiotics and overall treatment period. View Full-Text
Keywords: pyogenic; vertebral osteomyelitis; therapeutic response; clinical assessment; positron emission tomography; false positive pyogenic; vertebral osteomyelitis; therapeutic response; clinical assessment; positron emission tomography; false positive
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MDPI and ACS Style

Jeon, I.; Yu, D.; Kong, E. Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET. Medicina 2021, 57, 809. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080809

AMA Style

Jeon I, Yu D, Kong E. Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET. Medicina. 2021; 57(8):809. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080809

Chicago/Turabian Style

Jeon, Ikchan, Dongwoo Yu, and Eunjung Kong. 2021. "Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET" Medicina 57, no. 8: 809. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080809

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