Recurrent surgical site infection of the spine diagnosed by dual (18)F-NaF-bone PET/CT with early-phase scan

Abstract

We report a case of a 31-year-old man who showed recurrently elevated level of the serum inflammatory marker C-reactive protein (CRP) after spinal operation. He underwent (18)F-flurodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) and dual (18)F-sodium-fluoride ((18)F-NaF) PET/CT with an additional early-phase scan to find a hidden inflammation focus. Only mildly increased (18)F-FDG was found at the surgical site of T11 spine on (18)F-FDG PET/CT. In contrast, dual (18)F-NaF bone PET/CT with early-phase scan demonstrated focal active inflammation at the surgical site of T11 spine. After a revision operation of the T11 spine, serum CRP level decreased to the normal range without any symptom or sign of inflammation. Inflammatory focus in the surgical site of the spine can be detected with using dual (18)F-NaF bone PET/CT scan with early-phase scan.