Skip to main content
Log in

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

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

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 [18F]FDG PET and [18F]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options.

Methods

[18F]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

[18F]FDG PET is able to identify with high sensitivity the presence of osteomyelitis in orthopaedic surgery patients with nonspecific clinical symptoms of infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Harris JC, Caesar DH, Davison C, Phibbs R, Than MP. How useful are laboratory investigations in the emergency department evaluation of possible osteomyelitis? Emerg Med Australas. 2011;23:317–30. doi:10.1111/j.1742-6723.2011.01413.x.

    Article  PubMed  Google Scholar 

  2. Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009;23:80–9. doi:10.1055/s-0029-1214160.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Bernard L, Lubbeke A, Stern R, Bru JP, Feron JM, Peyramond D, et al. Value of preoperative investigations in diagnosing prosthetic joint infection: retrospective cohort study and literature review. Scand J Infect Dis. 2004;36:410–6.

    Article  PubMed  Google Scholar 

  4. Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B:1450–2. doi:10.1302/0301-620X.95B11.33135.

    Article  CAS  PubMed  Google Scholar 

  5. Stumpe KD, Strobel K. 18F FDG-PET imaging in musculoskeletal infection. Q J Nucl Med Mol Imaging. 2006;50:131–42.

    CAS  PubMed  Google Scholar 

  6. Wang GL, Zhao K, Liu ZF, Dong MJ, Yang SY. A meta-analysis of fluorodeoxyglucose-positron emission tomography versus scintigraphy in the evaluation of suspected osteomyelitis. Nucl Med Commun. 2011;32:1134–42. doi:10.1097/MNM.0b013e32834b455c.

    Article  PubMed  Google Scholar 

  7. Vijayanathan S, Butt S, Gnanasegaran G, Groves AM. Advantages and limitations of imaging the musculoskeletal system by conventional radiological, radionuclide, and hybrid modalities. Semin Nucl Med. 2009;39:357–68. doi:10.1053/j.semnuclmed.2009.07.001.

    Article  PubMed  Google Scholar 

  8. Brown TL, Spencer HJ, Beenken KE, Alpe TL, Bartel TB, Bellamy W, et al. Evaluation of dynamic [18F]-FDG-PET imaging for the detection of acute post-surgical bone infection. PLoS One. 2012;7:e41863. doi:10.1371/journal.pone.0041863.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Concia E, Prandini N, Massari L, Ghisellini F, Consoli V, Menichetti F, et al. Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun. 2006;27:645–60.

    Article  PubMed  Google Scholar 

  10. Tice AD, Hoaglund PA, Shoultz DA. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J Med. 2003;114:723–8.

    Article  CAS  PubMed  Google Scholar 

  11. Demirev A, Weijers R, Geurts J, Mottaghy F, Walenkamp G, Brans B. Comparison of [18F]FDG PET/CT and MRI in the diagnosis of active osteomyelitis. Skelet Radiol. 2014;43:665–72. doi:10.1007/s00256-014-1844-3.

    Article  Google Scholar 

  12. Vos FJ, Bleeker-Rovers CP, Corstens FH, Kullberg BJ, Oyen WJ. FDG-PET for imaging of non-osseous infection and inflammation. Q J Nucl Med Mol Imaging. 2006;50:121–30.

    CAS  PubMed  Google Scholar 

  13. Palestro CJ. Radionuclide imaging of osteomyelitis. Semin Nucl Med. 2015;45:32–46. doi:10.1053/j.semnuclmed.2014.07.005.

    Article  PubMed  Google Scholar 

  14. Termaat MF, Raijmakers PG, Scholten HJ, Bakker FC, Patka P, Haarman HJ. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am. 2005;87:2464–71. doi:10.2106/JBJS.D.02691.

    Article  CAS  PubMed  Google Scholar 

  15. Guhlmann A, Brecht-Krauss D, Suger G, Glatting G, Kotzerke J, Kinzl L, et al. Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings. Radiology. 1998;206:749–54.

    Article  CAS  PubMed  Google Scholar 

  16. Guhlmann A, Brecht-Krauss D, Suger G, Glatting G, Kotzerke J, Kinzl L, et al. Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis. J Nucl Med. 1998;39:2145–52.

    CAS  PubMed  Google Scholar 

  17. Zhuang H, Duarte PS, Pourdehand M, Shnier D, Alavi A. Exclusion of chronic osteomyelitis with F-18 fluorodeoxyglucose positron emission tomographic imaging. Clin Nucl Med. 2000;25:281–4.

    Article  CAS  PubMed  Google Scholar 

  18. Ichiya Y, Kuwabara Y, Sasaki M, Yoshida T, Akashi Y, Murayama S, et al. FDG-PET in infectious lesions: the detection and assessment of lesion activity. Ann Nucl Med. 1996;10:185–91.

    Article  CAS  PubMed  Google Scholar 

  19. Sugawara Y, Braun DK, Kison PV, Russo JE, Zasadny KR, Wahl RL. Rapid detection of human infections with fluorine-18 fluorodeoxyglucose and positron emission tomography: preliminary results. Eur J Nucl Med. 1998;25:1238–43.

    Article  CAS  PubMed  Google Scholar 

  20. Kalicke T, Schmitz A, Risse JH, Arens S, Keller E, Hansis M, et al. Fluorine-18 fluorodeoxyglucose PET in infectious bone diseases: results of histologically confirmed cases. Eur J Nucl Med. 2000;27:524–8.

    Article  CAS  PubMed  Google Scholar 

  21. Stumpe KD, Dazzi H, Schaffner A, von Schulthess GK. Infection imaging using whole-body FDG-PET. Eur J Nucl Med. 2000;27:822–32.

    Article  CAS  PubMed  Google Scholar 

  22. Hartmann A, Eid K, Dora C, Trentz O, von Schulthess GK, Stumpe KD. Diagnostic value of 18F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis. Eur J Nucl Med Mol Imaging. 2007;34:704–14. doi:10.1007/s00259-006-0290-4.

    Article  PubMed  Google Scholar 

  23. Kwee TC, Kwee RM, Alavi A. FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis. Eur J Nucl Med Mol Imaging. 2008;35:2122–32. doi:10.1007/s00259-008-0887-x.

    Article  PubMed  Google Scholar 

  24. Stumpe KD, Notzli HP, Zanetti M, Kamel EM, Hany TF, Gorres GW, et al. FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology. 2004;231:333–41. doi:10.1148/radiol.2312021596.

    Article  PubMed  Google Scholar 

  25. Reinartz P, Mumme T, Hermanns B, Cremerius U, Wirtz DC, Schaefer WM, et al. Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. J Bone Joint Surg Br. 2005;87:465–70. doi:10.1302/0301-620X.87B4.14954.

    Article  CAS  PubMed  Google Scholar 

  26. Chacko TK, Zhuang H, Stevenson K, Moussavian B, Alavi A. The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses. Nucl Med Commun. 2002;23:851–5.

    Article  CAS  PubMed  Google Scholar 

  27. Love C, Marwin SE, Tomas MB, Krauss ES, Tronco GG, Bhargava KK, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging. J Nucl Med. 2004;45:1864–71.

    PubMed  Google Scholar 

  28. Familiari D, Glaudemans AW, Vitale V, Prosperi D, Bagni O, Lenza A, et al. Can sequential 18F-FDG PET/CT replace WBC imaging in the diabetic foot? J Nucl Med. 2011;52:1012–9. doi:10.2967/jnumed.110.082222.

    Article  PubMed  Google Scholar 

  29. Poultsides LA, Liaropoulos LL, Malizos KN. The socioeconomic impact of musculoskeletal infections. J Bone Joint Surg Am. 2010;92:e13. doi:10.2106/JBJS.I.01131.

    Article  PubMed  Google Scholar 

  30. Schiesser M, Stumpe KD, Trentz O, Kossmann T, Von Schulthess GK. Detection of metallic implant-associated infections with FDG PET in patients with trauma: correlation with microbiologic results. Radiology. 2003;226:391–8.

    Article  PubMed  Google Scholar 

  31. de Winter F, van de Wiele C, Vogelaers D, de Smet K, Verdonk R, Dierckx RA. Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections. J Bone Joint Surg Am. 2001;83-A:651–60.

    PubMed  Google Scholar 

  32. van der Bruggen W, Bleeker-Rovers CP, Boerman OC, Gotthardt M, Oyen WJ. PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review. Semin Nucl Med. 2010;40:3–15. doi:10.1053/j.semnuclmed.2009.08.005.

    Article  PubMed  Google Scholar 

  33. Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K. The use of [18F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses. Nucl Med Commun. 2002;23:645–53.

    Article  CAS  PubMed  Google Scholar 

  34. Van Acker F, Nuyts J, Maes A, Vanquickenborne B, Stuyck J, Bellemans J, et al. FDG-PET, 99mTc-HMPAO white blood cell SPET and bone scintigraphy in the evaluation of painful total knee arthroplasties. Eur J Nucl Med. 2001;28:1496–504. doi:10.1007/s002590100603.

    Article  PubMed  Google Scholar 

  35. Militz M, Uhde J, Christian G, Linke R, Morgenstern M, Hungerer S. FDG PET/CT dataset for navigation on femoral bone: a feasibility study. Biomed Tech (Berl). 2015. doi:10.1515/bmt-2014-0160

    Google Scholar 

Download references

Acknowledgments

Language editing of the manuscript was performed by Inglewood Biomedical Editing.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marcus Hacker.

Ethics declarations

Conflicts of interest

None.

Ethical approval

All retrospective analyses involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Marcus Hacker and Sven Hungerer shared authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wenter, V., Müller, JP., Albert, N.L. et al. The diagnostic value of [18F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection. Eur J Nucl Med Mol Imaging 43, 749–761 (2016). https://doi.org/10.1007/s00259-015-3221-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-015-3221-4

Keywords

Navigation