Review ArticleReal-world experience of the role of 18F FDG PET-computed tomography in chronic spinal implant infectionBrown, Philip H.a; Carter, Joseph R.a; Moyade, Pamelab; Mohammed, Mohammeda; De Matas, Marcusa; Vinjamuri, SobhanbAuthor Information Departments of aOrthopaedic Surgery bNuclear Medicine, Royal Liverpool University Hospital, Liverpool, UK Received 27 March 2020 Accepted 13 April 2020 Correspondence to Philip H. Brown, MBChB, BSc, Department of Orthopaedic Surgery, Royal Liverpool University Hospital, Prescot St, Liverpool L7 8XP, UK, Tel: +44 151 706 200; e-mail: firstname.lastname@example.org Nuclear Medicine Communications: August 2020 - Volume 41 - Issue 8 - p 715-720 doi: 10.1097/MNM.0000000000001211 Buy Metrics Abstract Objectives The presence of postinstrumentation back pain in patients after undergoing spinal surgery is a well established phenomenon. So too is the presence of infection, both overt and subclinical which can be a source of pain. The accurate assessment of infection in patients with spinal implants in situ and no overt radiological or biochemical abnormalities frequently presents a diagnostic challenge. We present our experience spanning 5 years of using 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (18F FDG PET)-computed tomography (CT) scans to aid the diagnostic process in treating presumed low-grade chronic implant infection. Methods We undertook a retrospective analysis of all patients with spinal implants in place who were referred for 18F FDG PET-CT imaging over a 5-year period. All available images, case notes and laboratory results were reviewed. Results Data pertaining to 49 patients were analysed, with infection diagnosed on 18F FDG PET-CT in 24 (45%) of those sent for scanning. Fifteen patients in the cohort underwent revision surgery, and 11 of whom had been diagnosed as infected on PET-CT. Confirmation of infection with positive microbiological sampling occurred in 8/11 giving a positive predictive value of 0.72 in our series. Conclusion We present a real-world experience of using 18F FDG PET-CT as a diagnostic tool in the evaluation of patients with chronic pain after undergoing spinal implantation. We have found PET-CT to be a promising modality and would recommend multicentre collaboration to ensure reproducibility across more centres. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.