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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 (2016): The diagnostic value of [F-18]FDG PET for the detection of chronic osteomyelitis and implant-associated infection. In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 43, No. 4: pp. 749-761
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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 [F-18]FDG PET and [F-18]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options. Methods [F-18]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 [F-18]FDG PET is able to identify with high sensitivity the presence of osteomyelitis in orthopaedic surgery patients with nonspecific clinical symptoms of infection.