title: Follow-up of acute osteomyelitis in children: the possible role of PET/CT in selected cases.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) and/or scintigraphy are commonly used for follow-up in children after treatment of acute osteomyelitis. Regularly, post-treatment imaging reveals pathological findings even if serum inflammatory parameters and clinical presentation are normal. We analyzed combined positron emission tomography and multislice computed tomography (PET/CT) for this condition.
  
  
  METHODS
  Six children received PET/CT after treatment of acute osteomyelitis. Post-treatment MRI had revealed suspicious residual and/or additional findings. All patients had physiological serum infection parameters and no clinical symptoms.
  
  
  RESULTS
  Median patient age was 59.5 months (range, 48-156). No increased 18-Fluor-2-deoxy-D-glucose uptake was observed in 3 patients. In 3 patients, there was minimal activity at the site of infection, which, however, did not reach the presumed range of osteomyelitis. All children were taken off antibiotic medication. No clinical symptoms reoccurred in any of them, and repeatedly controlled serum infection parameters were all normal. Median follow-up was 33 months (range, 4-65).
  
  
  CONCLUSIONS
  The PET/CT was superior to MRI in distinguishing between infection and reparative activity within the musculoskeletal system in selected children after acute osteomyelitis. The termination of antibiotic treatment for children after acute osteomyelitis seems justified when laboratory parameters as well as clinical presentation are normal, and PET/CT scan is unsuspicious.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital, 72076 Tübingen, Germany. steven.warmann@med.uni-tuebingen.de
authors.forename: Steven W
authors.initials: SW
authors.lastname: Warmann
authors.forename: Helmut
authors.initials: H
authors.lastname: Dittmann
authors.forename: Guido
authors.initials: G
authors.lastname: Seitz
authors.forename: Roland
authors.initials: R
authors.lastname: Bares
authors.forename: Jörg
authors.initials: J
authors.lastname: Fuchs
authors.forename: Jürgen F
authors.initials: JF
authors.lastname: Schäfer
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D010019:Osteomyelitis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D010400:Penicillin G / Q000627:therapeutic use; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D010400:Penicillin G