title: The diagnostic value of [(18)F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  [(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.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Munich, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Wenter
authors.affiliation: BG Trauma Center Murnau, Murnau, Germany.|PMU Salzburg, Salzburg, Austria.
authors.forename: Jan-Phillip
authors.initials: JP
authors.lastname: Müller
authors.affiliation: Department of Nuclear Medicine, University of Munich, Munich, Germany.
authors.forename: Nathalie L
authors.initials: NL
authors.lastname: Albert
authors.affiliation: Department of Nuclear Medicine, University of Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lehner
authors.affiliation: Department of Nuclear Medicine, University of Munich, Munich, Germany.
authors.forename: Wolfgang P
authors.initials: WP
authors.lastname: Fendler
authors.affiliation: Department of Nuclear Medicine, University of Munich, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.affiliation: Institute for Clinical Radiology, University of Munich, Munich, Germany.
authors.forename: Clemens C
authors.initials: CC
authors.lastname: Cyran
authors.affiliation: BG Trauma Center Murnau, Murnau, Germany.|PMU Salzburg, Salzburg, Austria.
authors.forename: Jan
authors.initials: J
authors.lastname: Friederichs
authors.affiliation: BG Trauma Center Murnau, Murnau, Germany.|PMU Salzburg, Salzburg, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Militz
authors.affiliation: Department of Nuclear Medicine, University of Vienna, Vienna, Austria. marcus.hacker@meduniwien.ac.at.|Department of Biomedical Imaging and Image-guided Therapy, Währinger Gürtel 18-20, Floor 5L, 1090, Vienna, Austria. marcus.hacker@meduniwien.ac.at.
authors.forename: Marcus
authors.initials: M
authors.lastname: Hacker
authors.affiliation: BG Trauma Center Murnau, Murnau, Germany.|PMU Salzburg, Salzburg, Austria.
authors.forename: Sven
authors.initials: S
authors.lastname: Hungerer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010019:Osteomyelitis / Q000601:surgery*; D049268:Positron-Emission Tomography; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Chronic osteomyelitis; Implant-associated infection; Infection imaging; PET/CT; [18F]FDG PET