title: Blood perfusion in osteomyelitis studied with [15O]water PET in a juvenile porcine model.
abstract: BACKGROUND
  Osteomyelitis is a serious disease which can be difficult to treat despite properly instituted antibiotic therapy. This appears to be related at least partly to degraded vascularisation in the osteomyelitic (OM) lesions. Studies of perfusion in OM bones are, however, few and not quantitative. Quantitative assessment of perfusion could aid in the selection of therapy. A non-invasive, quantitative way to study perfusion is dynamic [15O]water positron emission tomography (PET). We aim to demonstrate that the method can be used for measuring perfusion in OM lesions and hypothesize that perfusion will be less elevated in OM lesions than in soft tissue (ST) infection. The study comprised 11 juvenile pigs with haematogenous osteomyelitis induced by injection of Staphylococcus aureus into the right femoral artery 1 week before scanning (in one pig, 2 weeks). The pigs were dynamically PET scanned with [15O]water to quantify blood perfusion. OM lesions (N = 17) in long bones were studied, using the left limb as reference. ST lesions (N = 8) were studied similarly.
  
  
  RESULTS
  Perfusion was quantitatively determined. Perfusion was elevated by a factor 1.5 in OM lesions and by a factor 6 in ST lesions.
  
  
  CONCLUSIONS
  Blood perfusion was successfully determined in pathological subacute OM lesions; average perfusion was increased compared to that in a healthy bone, but as hypothesized, the increase was less than in ST lesions, indicating that the infected bone has less perfusion reserve than the infected soft tissue.
authors.affiliation: Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark. lajo@rn.dk.|Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark. lajo@rn.dk.|Department of Nuclear Medicine, Aalborg University Hospital, P.O. Box 365, 9100, Aalborg, Denmark. lajo@rn.dk.
authors.forename: Lars
authors.identifier: http://orcid.org/0000-0002-6811-0172
authors.initials: L
authors.lastname: Jødal
authors.affiliation: Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Ole L
authors.initials: OL
authors.lastname: Nielsen
authors.affiliation: Department of Diagnostic Imaging, North Zealand Hospital, Hillerød, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Afzelius
authors.affiliation: Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Aage K O
authors.initials: AKO
authors.lastname: Alstrup
authors.affiliation: Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren B
authors.initials: SB
authors.lastname: Hansen
keywords: Bone infection; Osteomyelitis; Perfusion; Positron emission tomography; Swine; [15O]water