title: Evaluation of dynamic [18F]-FDG-PET imaging for the detection of acute post-surgical bone infection.
abstract: Diagnosing bone infection in its acute early stage is of utmost clinical importance as the failure to do so results in a therapeutically recalcitrant chronic infection that can only be resolved with extensive surgical intervention, the end result often being a structurally unstable defect requiring reconstructive procedures. [(18)F]-FDG-PET has been extensively investigated for this purpose, but the results have been mixed in that, while highly sensitive, its specificity with respect to distinguishing between acute infection and sterile inflammatory processes, including normal recuperative post-surgical healing, is limited. This study investigated the possibility that alternative means of acquiring and analyzing FDG-PET data could be used to overcome this lack of specificity without an unacceptable loss of sensitivity. This was done in the context of an experimental rabbit model of post-surgical osteomyelitis with the objective of distinguishing between acute infection and sterile post-surgical inflammation. Imaging was done 7 and 14 days after surgery with continuous data acquisition for a 90-minute period after administration of tracer. Results were evaluated based on both single and dual time point data analysis. The results suggest that the diagnostic utility of FDG-PET is likely limited to well-defined clinical circumstances. We conclude that, in the complicated clinical context of acute post-surgical or post-traumatic infection, the diagnostic utility accuracy of FDG-PET is severely limited based on its focus on the increased glucose utilization that is generally characteristic of inflammatory processes.
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.
authors.forename: Tracy L Y
authors.initials: TL
authors.lastname: Brown
authors.forename: Horace J
authors.initials: HJ
authors.lastname: Spencer
authors.forename: Karen E
authors.initials: KE
authors.lastname: Beenken
authors.forename: Terri L
authors.initials: TL
authors.lastname: Alpe
authors.forename: Twyla B
authors.initials: TB
authors.lastname: Bartel
authors.forename: William
authors.initials: W
authors.lastname: Bellamy
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gruenwald
authors.forename: Robert A
authors.initials: RA
authors.lastname: Skinner
authors.forename: Sandra G
authors.initials: SG
authors.lastname: McLaren
authors.forename: Mark S
authors.initials: MS
authors.lastname: Smeltzer
mesh_terms: D000818:Animals; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000382:microbiology; D049268:Positron-Emission Tomography; D011817:Rabbits; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D011884:Radius / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000382:microbiology; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging* / Q000382:microbiology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18