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Shyam K, Bhari Thippeswamy P, Shetty AP, Algeri R, Rajasekaran S. Gauze for concern: A Case Report and systematic review of delayed presentation of paraspinal textiloma. J Clin Orthop Trauma 2022; 32:101967. [PMID: 36051862 PMCID: PMC9424584 DOI: 10.1016/j.jcot.2022.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022] Open
Abstract
Textilomas, gossypibomas, muslinomas and gauzomas, otherwise collectively known as Retained Non-absorbable Hemostatic Material (RNHM), are surgical materials such as cotton or gauze pads that are accidentally retained in the surgical bed post-operatively. They may present acutely with signs of infection or may rarely remain chronic and asymptomatic; the latter posing a significant challenge to clinical and imaging diagnosis. Textilomas are not routinely reported due to their medicolegal implications and are usually encountered fortuitously. Here, we report a case of an individual who presented with a non-specific lower backache, had a remote history of lumbar discectomy and in whom a textiloma at the postoperative site was seen to mimic a soft-tissue mass on imaging. In addition, we review current, up-to-date literature on delayed presentations of such retained materials after surgery of the lumbar spine. Case report A 43-year-old male presented with pain in his right lower back and gluteal region. He had undergone an L4-L5 discectomy 11 years ago, remained asymptomatic since, and noticed an insidious, worsening pain a week before presentation. Mild tenderness was elicited over the region of pain. A clinical diagnosis of L4-L5 extraforaminal disc prolapse with deep surgical site infection was made. Ultrasound showed an iso-to-hyperechogenic lesion in the right lower paraspinal region. MRI showed a very well-defined, ovoid T1-hypointense and T2-iso-hypointense lesion in the deep posterior paraspinal region of the L4/5 level adjacent to right laminar process of L4 vertebra. The lesion caused scalloping and chronic erosion of the laminar process. No obvious air pockets were present. The features of infection, like soft tissue oedema and collection, were absent. Based on imaging, differentials of nerve sheath tumour and gossipybomas was made. Open wound exploration was performed, which showed a wad of gauze within the right L4-L5 interlaminar space, with thin surrounding granulation tissue. The L4-L5 disc and exiting nerve root were normal. The mass was removed, local washing was done and wound was closed. Conclusion Though unfortunate and relatively rare, the possibility of a textiloma must be considered among the differential diagnoses of a mass in the spinal region in the event of prior surgery, no matter how remote the history. Clinical presentation may vary, but the imaging appearance is largely consistent and can be relied upon to prevent unnecessary investigation and facilitate early surgical removal of the offending retained material.
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Affiliation(s)
- Karthik Shyam
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Ajoy Prasad Shetty
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Raksha Algeri
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
| | - Shanmuganathan Rajasekaran
- Department of Radiology, Ganga Medical Center and Hospital, Mettupalayam Main Road, Coimbatore, Tamil Nadu, 641009, India
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Lotfinia I, Mahdkhah A. Spinal Textiloma After Diskectomy: A Case Report and Review of the Literature. World Neurosurg 2019; 134:343-347. [PMID: 31520757 DOI: 10.1016/j.wneu.2019.08.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Spinal masses can be diagnosed by clinical and radiographic examinations. Infrequently, pseudotumors may be due to retained masses after surgical interventions. In fact, these spinal or paraspinal expansions are caused by iatrogenic foreign bodies. Pseudotumors are mentioned as textilomas. CASE DESCRIPTION We present a case of a patient with a history of lumbar diskectomy in the L2-L3 segments performed in 2017. A 53-year-old woman was admitted with the complaint of persistent mechanical lower back and leg pain for 2 months. CONCLUSIONS There are no specific clinical and paraclinical manifestations for retained surgical foreign bodies. The number of cases of textilomas associated with spinal surgery are few in comparison with abdominal or thoracic interventions. It is better to integrate textiloma in the differential diagnosis of soft-tissue masses in the paraspinal region with surgical history. Although the definitive treatment of textilomas is surgical elimination of the foreign body, exact evaluation of surgical site before its closure is essential to prevent these cases.
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Affiliation(s)
- Iraj Lotfinia
- Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahdkhah
- Department of Neurosurgery, Urmia University of Medical Sciences, Urmia, Iran.
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Zoller SD, Park HY, Olafsen T, Zamilpa C, Burke ZD, Blumstein G, Sheppard WL, Hamad CD, Hori KR, Tseng JC, Czupryna J, McMannus C, Lee JT, Bispo M, Romero Pastrana F, Raineri EJ, Miller JF, Miller LS, van Dijl JM, Francis KP, Bernthal NM. Multimodal imaging guides surgical management in a preclinical spinal implant infection model. JCI Insight 2019; 4:124813. [PMID: 30728332 DOI: 10.1172/jci.insight.124813] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/09/2019] [Indexed: 01/16/2023] Open
Abstract
Spine implant infections portend disastrous outcomes, as diagnosis is challenging and surgical eradication is at odds with mechanical spinal stability. Current imaging modalities can detect anatomical alterations and anomalies but cannot differentiate between infection and aseptic loosening, diagnose specific pathogens, or delineate the extent of an infection. Herein, a fully human monoclonal antibody 1D9, recognizing the immunodominant staphylococcal antigen A on the surface of Staphylococcus aureus, was assessed as a nuclear and fluorescent imaging probe in a preclinical model of S. aureus spinal implant infection, utilizing bioluminescently labeled bacteria to confirm the specificity and sensitivity of this targeting. Postoperative mice were administered 1D9 probe dual labeled with 89-zirconium (89Zr) and a bars represent SEM dye (NIR680) (89Zr-NIR680-1D9), and PET-CT and in vivo fluorescence and bioluminescence imaging were performed. The 89Zr-NIR680-1D9 probe accurately diagnosed both acute and subacute implant infection and permitted fluorescent image-guided surgery for selective debridement of infected tissue. Therefore, a single probe could noninvasively diagnose an infection and facilitate image-guided surgery to improve the clinical management of implant infections.
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Affiliation(s)
- Stephen D Zoller
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Howard Y Park
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Tove Olafsen
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California, USA
| | - Charles Zamilpa
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California, USA
| | - Zachary Dc Burke
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Gideon Blumstein
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - William L Sheppard
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | | | - Kellyn R Hori
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | | | | | - Jason T Lee
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California, USA
| | - Mafalda Bispo
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Francisco Romero Pastrana
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisa Jm Raineri
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jeffery F Miller
- California NanoSystems Institute, UCLA, Los Angeles, California, USA.,Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Lloyd S Miller
- Department of Orthopaedic Surgery.,Department of Dermatology, and.,Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kevin P Francis
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA.,PerkinElmer, Hopkinton, Massachusetts, USA
| | - Nicholas M Bernthal
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
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Turgut M, Akhaddar A, Turgut AT. Retention of Nonabsorbable Hemostatic Materials (Retained Surgical Sponge, Gossypiboma, Textiloma, Gauzoma, Muslinoma) After Spinal Surgery: A Systematic Review of Cases Reported During the Last Half-Century. World Neurosurg 2018; 116:255-267. [PMID: 29807184 DOI: 10.1016/j.wneu.2018.05.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Retention of nonabsorbable hemostatic materials (RNHMs), that is, retained surgical sponge, gauzoma, gossypiboma, muslinoma, or textiloma, is a rarely seen surgical complication after spinal surgery that may remain asymptomatic for many years and may represent a diagnostic difficulty with associated medicolegal implications. METHODS We performed a systematic review of the English-language literature published between 1965 and 2017, accessed through 4 popular databases. We found a total of 37 articles (24 case reports; 7 image presentations; 5 clinical series, and 1 letter to editor) containing 58 cases of RNHMs located within the spinal canal or around the spinal column after surgery. RESULTS In this study, there were 29 female and 29 male patients from 13 countries, ages ranging from 17 years to 87 years, with initial diagnoses of lumbar or cervical disc herniation, spinal stenosis, or spondylolisthesis (n = 54), or spinal tumor (n = 4). The interval from the initial surgery to the presentation of RNHMs ranged from 13 days to 40 years, with a mean of 75.9 months. Various imaging techniques such as computed tomography and magnetic resonance imaging were used with histologic study, confirming the presence of RNHMs in the majority of patients with a complete recovery resulting in 93% of patients. CONCLUSIONS RNHMs is an overreported entity in underdeveloped or developing countries, including Turkey and Morocco, with progression occurring over years. RNHMs should be considered in the differential diagnosis of any patient who presents with back pain, spinal cord, or nerve roots symptomatology after spinal surgery.
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Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydın, Turkey.
| | - Ali Akhaddar
- Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V. University in Rabat, Rabat, Morocco
| | - Ahmet T Turgut
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Meshkini A, Salehpour F, Rezakhah A, Mirzaei F, Kazemzadeh M, Naseri Alavi SA. Textiloma: A Case of Foreign Body Mimicking a Spinal Tumor. Spine (Phila Pa 1976) 2017; 42:E1272-E1274. [PMID: 28338580 DOI: 10.1097/brs.0000000000002164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report OBJECTIVE.: To report a case of foreign body mimicking spinal tumor. SUMMARY OF BACKGROUND DATA Gossypiboma or more broadly retained foreign object is a surgical complication resulting from foreign materials such as cotton or gauze pads and surgical sponge, accidentally left inside a patient's body. Such foreign materials cause foreign body reaction in the surrounding tissue. METHODS A retrospective case report was performed. Informed consent was obtained from patient. RESULTS We describe a case of textiloma in which the patient presented with low back pain and radiculopathy 12 years after L5\S1 discectomy. Imaging revealed a round mass lesion in the sacral space. CONCLUSION At the end of surgery, the operative site should be flushed with saline and carefully examined for any foreign materials. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Ali Meshkini
- Department of Neurosurgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Georgakopoulos A, Pneumaticos SG, Sipsas NV, Chatziioannou S. Positron emission tomography in spinal infections. Clin Imaging 2015; 39:553-8. [PMID: 25914050 DOI: 10.1016/j.clinimag.2015.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/05/2015] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging is the imaging method of choice for diagnosing infection of the spine in unoperated cases. 2-[(18)F]-fluoro-2deoxy-d-glucose positron emission tomography/computed tomography study is recommended to distinguish between spinal infection and common Modic change in patients with metallic implants and prosthetic replacements and for differentiating tuberculous from pyogenic spondylitis in ambiguous cases, reflecting the activity of the infection. Also, it seems to have a strong clinical impact in more than half of patients with infectious spondylitis, while it is superior to other imaging techniques in revealing residual disease after treatment and early response to therapy. New tracers as well as new hybrid modalities are under investigation.
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Affiliation(s)
- Alexandros Georgakopoulos
- Nuclear Medicine Division, PET/CT section, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece.
| | - Spiros G Pneumaticos
- 3rd Department of Orthopedic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Chatziioannou
- Nuclear Medicine Division, PET/CT section, Foundation for Biomedical Research of the Academy of Athens, Athens, Greece; Second Department of Radiology, Medical School, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Athens, Greece
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Sahin S, Atabey C, Simşek M, Naderi S. Spinal textiloma (gossypiboma): a report of three cases misdiagnosed as tumour. Balkan Med J 2013; 30:422-8. [PMID: 25207152 DOI: 10.5152/balkanmedj.2013.8732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. AIMS The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. STUDY DESIGN Retrospective study. METHODS This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. RESULTS The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. CONCLUSION Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes.
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Affiliation(s)
- Soner Sahin
- Department of Neurosurgery, Kocaeli Derince Research and Teaching Hospital, Kocaeli, Turkey
| | - Cem Atabey
- Department of Neurosurgery, Gülhane Military Academy Haydarpaşa Training Hospital, İstanbul, Turkey
| | - Mehmet Simşek
- Department of Neurosurgery, Ümraniye Research and Teaching Hospital, İstanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, Ümraniye Research and Teaching Hospital, İstanbul, Turkey
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Bahçeci T, Nursal GN, Aydın M. Intense FDG Uptake around the Inguinal Surgical Mesh 5 Years after Operation: Case Report and Review of the Literature. Mol Imaging Radionucl Ther 2012; 21:35-7. [PMID: 23486372 PMCID: PMC3590964 DOI: 10.4274/mirt.021917] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 09/06/2011] [Indexed: 12/01/2022] Open
Abstract
UNLABELLED We present the case of a 40-year-old man who underwent a FDG PET/CT study for restaging of renal cell carcinoma treated with left nephrectomy, for suspected metastasis in lung and retroperitoneal lymph nodes. The patient had a history of left inguinal hernia repair with implantation of mesh prosthesis 5 years ago. PET/CT image revealed linear intense FDG uptake in left inguinal region most likely corresponding to a persistent foreign body reaction. In this article, a case with an intense FDG uptake around mesh prosthesis after many years was reported, and a summary of the literature about surgical mesh and foreign body reaction causing FDG uptake was reviewed. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Tatiana Bahçeci
- Başkent University, Department of Nuclear Medicine, Ankara, Turkey
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False-positive F-18 FDG PET/CT from foreign body reaction on anterior chest wall after endoscopic total thyroidectomy via axillo-breast approach for thyroid cancer: two case reports. Clin Nucl Med 2011; 36:1036-8. [PMID: 21975398 DOI: 10.1097/rlu.0b013e31821c99f5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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F-18 FDG PET of foreign body granuloma: pathologic correlation with imaging features in 3 cases. Clin Nucl Med 2011; 35:853-7. [PMID: 20940541 DOI: 10.1097/rlu.0b013e3181f483da] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Retained textiles with foreign body granulomatous reaction can form mass-mimicking soft tissue tumors, which may cause diagnostic, clinical, and medicolegal problems. In this study, we present 3 cases of foreign body granuloma by retained textiles, and demonstrate FDG PET findings with detailed pathologic correlation. We also provide a review of previous literatures. MATERIALS AND METHODS Three patients (all females; age range, 48-61 years) with histopathologic diagnosis of mass-forming foreign body granuloma caused by retained textiles were retrospectively studied. They underwent an FDG PET scan in our institute. The mass was located in the abdominopelvic cavity in all cases. The time interval between the prior surgery and the PET acquisition was 11 months, 15 or 19 years, and 26 years, respectively. RESULTS Intense FDG uptake with a ring-shaped pattern was observed in 2 cases, while no uptake in 1 case. Microscopically, 2 with ring-shaped FDG uptake showed a cellular foreign body reaction peripherally, and artificial textile fibers and acellular eosinophilic amorphous materials in the central portion. In the one without FDG uptake, the mass was composed of mainly necrotic debris surrounding by a thick layer of well-formed collagen fibers. In previous case reports describing the accumulation of FDG in foreign body granulomas, 9 of 10 cases showed intense FDG uptake with a ring-shaped pattern. CONCLUSIONS The ring-shaped pattern of FDG uptake seems to well characterize pseudotumor with foreign body granulomas. However, the pattern of FDG accumulation in retained textile with foreign body granulomas may vary due to histologic features.
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Jung SA, Kim DW, Park SA, Kim CG. Abdominal Mesh Implant Showing FDG Uptake on PET/CT. Nucl Med Mol Imaging 2010; 44:223-5. [PMID: 24899954 DOI: 10.1007/s13139-010-0040-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 06/06/2010] [Accepted: 06/09/2010] [Indexed: 11/28/2022] Open
Abstract
F-18 fluorodeoxyglucose (FDG) uptake by a mesh implant might be caused by a foreign body granulomatous reaction with inflammation and fibrosis, which can be demonstrated by positron emission tomography/computed tomography (PET/CT). A 71-year-old man underwent F-18 FDG PET/CT for the follow-up evaluation after an operation for colonic adenocarcinoma. On PET/CT imaging, there was a rectangular-shaped FDG uptake (maximal standardized uptake value, maxSUV: 3.4) in the anterior abdominal wall. On the review of the medical records, the patient had a history of herniorrhapy for the reinforcement of the abdominal wall 2 months previously, using a mesh implant consisting of polytetrafluoroethylene (Teflon). We report a case of FDG uptake associated with surgical procedures including mesh implant on F-18 FDG PET/CT.
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Affiliation(s)
- Sang-Ah Jung
- Department of Nuclear Medicine, Wonkwang University School of Medicine, 344-2 Shinyong-Dong, Iksan, Jeollabuk-do 570-711 Republic of Korea
| | - Dae-Weung Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine, 344-2 Shinyong-Dong, Iksan, Jeollabuk-do 570-711 Republic of Korea
| | - Soon-Ah Park
- Department of Nuclear Medicine, Wonkwang University School of Medicine, 344-2 Shinyong-Dong, Iksan, Jeollabuk-do 570-711 Republic of Korea ; Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeollabuk-do Korea
| | - Chang Guhn Kim
- Department of Nuclear Medicine, Wonkwang University School of Medicine, 344-2 Shinyong-Dong, Iksan, Jeollabuk-do 570-711 Republic of Korea ; Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeollabuk-do Korea
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Gemmel F, Rijk PC, Collins JMP, Parlevliet T, Stumpe KD, Palestro CJ. Expanding role of 18F-fluoro-D-deoxyglucose PET and PET/CT in spinal infections. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:540-51. [PMID: 20052505 DOI: 10.1007/s00586-009-1251-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 11/10/2009] [Accepted: 12/10/2009] [Indexed: 12/19/2022]
Abstract
(18)F-fluoro-D -deoxyglucose positron emission tomography ([(18)F]-FDG PET) is successfully employed as a molecular imaging technique in oncology, and has become a promising imaging modality in the field of infection. The non-invasive diagnosis of spinal infections (SI) has been a challenge for physicians for many years. Morphological imaging modalities such as conventional radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are techniques frequently used in patients with SI. However, these methods are sometimes non-specific, and difficulties in differentiating infectious from degenerative end-plate abnormalities or postoperative changes can occur. Moreover, in contrast to CT and MRI, FDG uptake in PET is not hampered by metallic implant-associated artifacts. Conventional radionuclide imaging tests, such as bone scintigraphy, labeled leukocyte, and gallium scanning, suffer from relatively poor spatial resolution and lack sensitivity, specificity, or both. Initial data show that [(18)F]-FDG PET is an emerging imaging technique for diagnosing SI. [(18)F]-FDG PET appears to be especially helpful in those cases in which MRI cannot be performed or is non-diagnostic, and as an adjunct in patients in whom the diagnosis is inconclusive. The article reviews the currently available literature on [(18)F]-FDG PET and PET/CT in the diagnosis of SI.
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Affiliation(s)
- Filip Gemmel
- Department of Nuclear Medicine, KCL, Medical Center Leeuwarden, Borniastraat 34, 8934 AD Leeuwarden, The Netherlands.
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Gemmel F, Dumarey N, Palestro CJ. Radionuclide imaging of spinal infections. Eur J Nucl Med Mol Imaging 2007; 33:1226-37. [PMID: 16896656 DOI: 10.1007/s00259-006-0098-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnosis of spinal infection, with or without implants, has been a challenge for physicians for many years. Spinal infections are now being recognised more frequently, owing to aging of the population and the increasing use of spinal-fusion surgery. DISCUSSION The diagnosis in many cases is delayed, and this may result in permanent neurological damage or even death. Laboratory evidence of infection is variable. Conventional radiography and radionuclide bone imaging lack both sensitivity and specificity. Neither in vitro labelled leucocyte scintigraphy nor 99mTc-anti-granulocyte antibody scintigraphy is especially useful, because of the frequency with which spinal infection presents as a non-specific photopenic area on these tests. Sequential bone/gallium imaging and 67Ga-SPECT are currently the radionuclide procedures of choice for spinal osteomyelitis, but these tests lack specificity, suffer from poor spatial resolution and require several days to complete. [18F]Fluoro-2-deoxy-D-glucose (FDG) PET is a promising technique for diagnosing spinal infection, and has several potential advantages over conventional radionuclide tests. RESULTS The study is sensitive and is completed in a single session, and image quality is superior to that obtained with single-photon emitting tracers. The specificity of FDG-PET may also be superior to that of conventional tracers because degenerative bone disease and fractures usually do not produce intense FDG uptake; moreover, spinal implants do not affect FDG imaging. However, FDG-PET images have to be read with caution in patients with instrumented spinal-fusion surgery since non-specific accumulation of FDG around the fusion material is not uncommon. CONCLUSION In the future, PET-CT will likely provide more precise localisation of abnormalities. FDG-PET may prove to be useful for monitoring response to treatment in patients with spinal osteomyelitis. Other tracers for diagnosing spinal osteomyelitis are also under investigation, including radiolabelled antibiotics, such as 99mTc-ciprofloxacin, and radiolabelled streptavidin-biotin complex. Antimicrobial peptides display preferential binding to microorganisms over human cells and perhaps new radiopharmaceuticals will be recruited from the array of human antimicrobial peptides/proteins. In experiments with Tc-ubiquicidin-derived peptides, radioactivity at the site of infection correlated well with the number of viable bacteria present. Finally, radiolabelled antifungal tracers could potentially distinguish fungal from bacterial infections.
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Affiliation(s)
- Filip Gemmel
- Division of Nuclear Medicine, Ghent Maria-Middelares, General Hospital, Ghent, Belgium.
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Koljevic-Markovic A, Orcurto MV, Doenz F, Delaloye AB, Prior JO. Persistent FDG Uptake Around an Inguinal Mesh Prosthesis 25 Years After Implantation. Clin Nucl Med 2007; 32:242-3. [PMID: 17314611 DOI: 10.1097/01.rlu.0000255266.01340.c6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakajo M, Jinnouchi S, Tateno R, Nakajo M. 18F-FDG PET/CT findings of a right subphrenic foreign-body granuioma. Ann Nucl Med 2006; 20:553-6. [PMID: 17134023 DOI: 10.1007/bf03026820] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report a case of an 85-year-old woman with a foreign-body granuloma which accumulated 18F-fluorodeoxyglucose (FDG). Unenhanced computed tomography showed a hyperdense mass with a hypodense rim in the right subphrenic space. FDG PET/CT images showed intense FDG uptake in the hypodense rim and little FDG uptake in the center of the mass, showing a ring-shaped appearance. The fusion imaging of FDG PET/CT represented the metabolic features of the foreign-body granuloma. When a ring-shaped FDG uptake is noted in the abdomen of a patient with a history of abdominal surgery, a foreign-body granuloma should be included in the differential diagnosis.
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De Winter F, Gemmel F, Van De Wiele C, Poffijn B, Uyttendaele D, Dierckx R. 18-Fluorine fluorodeoxyglucose positron emission tomography for the diagnosis of infection in the postoperative spine. Spine (Phila Pa 1976) 2003; 28:1314-9. [PMID: 12811277 DOI: 10.1097/01.brs.0000065483.07790.34] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Using conventional imaging methods, including magnetic resonance imaging and labeled leukocyte scanning, the diagnosis of infection in the postoperative spine remains a diagnostic challenge. Recently, promising results have been reported using 18F-fluorodeoxyglucose positron emission tomography for various infectious problems. This study aimed to investigate the value of 18F-fluorodeoxyglucose positron emission tomography in patients suspected of having spinal infection after previous surgery of the spine. METHODS Fifty-seven consecutive patients with a history of previous spinal surgery were prospectively included between February 1999 and June 2001. 18F-fluorodeoxyglucose positron emission tomography was performed 60 to 90 minutes after injection of 370 MBq 18F-fluorodeoxyglucose. Images were scored visually and semiquantitatively by two blinded, independent, certified nuclear medicine physicians, experienced with positron emission tomography. Differences were assessed by consensus. Results were correlated with final diagnosis allowing calculation of sensitivity, specificity and accuracy. Receiver operating characteristic analysis was performed to find optimal cut-off values. RESULTS Fifteen patients had spinal infection. Using the most sensitive cut-off values sensitivity, specificity and accuracy were 100%, 81%, and 86%, respectively, for both visual and semiquantitative scoring. In the group without metallic implants (n = 27), false positives (n = 2) only occurred in the first 6 months after surgery. In the group with metallic implants (n = 30), false positives (n = 6) were not confined to recently operated patients. CONCLUSIONS Overall accuracy was excellent (86%) with a negative predictive value of 100%. 18F-fluorodeoxyglucose positron emission tomography holds promise to become the standard imaging technique in this difficult patient population, as it is straightforward, provides a rapid result (2 hours) and because accurate alternatives are lacking.
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