The diagnostic value of [18F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection

• Published in: European journal of nuclear medicine and molecular imaging 2016-04, Vol.43 (4), p.749-761
• Main Authors: Wenter, Vera, Müller, Jan-Phillip, Albert, Nathalie L., Lehner, Sebastian, Fendler, Wolfgang P., Bartenstein, Peter, Cyran, Clemens C., Friederichs, Jan, Militz, Matthias, Hacker, Marcus, Hungerer, Sven
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bacterial infections; Bone diseases; Cardiology; Female; Fluorodeoxyglucose F18; Humans; Imaging; Male; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Multimodal Imaging; Nuclear Medicine; Oncology; Original Article; Orthopedic Procedures - adverse effects; Orthopedics; Osteomyelitis - surgery; Positron-Emission Tomography; Prosthesis-Related Infections - diagnostic imaging; Radiology; Radiopharmaceuticals; Sensitivity and Specificity; Tomography; Tomography, X-Ray Computed; Transplants & implants
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-015-3221-4

Purpose The diagnosis of osteomyelitis and implant-associated infections in patients with nonspecific laboratory or radiological findings is often unsatisfactory. We retrospectively evaluated the contributions of [ 18 F]FDG PET and [ 18 F]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options. Methods [ 18 F]FDG PET or PET/CT was performed in 215 patients with suspected osteomyelitis or implant-associated infections between 2000 and 2013. We assessed the diagnostic accuracy of both modalities together and separately with reference to intraoperative microbial findings, with a mean clinical follow-up of 69 ± 49 months. Results Infections were diagnosed clinically in 101 of the 215 patients. PET and PET/CT scans revealed 87 true-positive, 76 true-negative, 38 false-positive, and 14 false-negative results, indicating a sensitivity of 86 %, a specificity of 67 %, a positive predictive value (PPV) of 70 %, a negative predictive value (NPV) of 84 % and an accuracy of 76 %. The sensitivity of PET/CT was 88 %, but specificity, PPV, NPV and accuracy (76 %, 76 %, 89 % and 82 %, respectively) were higher than those of stand-alone PET. Conclusion [ 18 F]FDG PET is able to identify with high sensitivity the presence of osteomyelitis in orthopaedic surgery patients with nonspecific clinical symptoms of infection.