18F FDG-PET imaging in musculoskeletal infection

(18)F Fluorodeoxyglucose-positron emission tomography (FDG-PET) has become an encouraging imaging modality in musculoskeletal infection. This application has an incremental value in the assessment of both acute and chronic infection and has shown to be more accurate in detecting chronic osteomyelitis than conventional radionuclide imaging. Whether FDG-PET has the potential to replace conventional scintigraphy completely depends on a number of factors, including cost and availability. Conventional radionuclide studies have represented imaging methods of choice in the diagnosis of implant-associated infection in patients with trauma so far. However, nonspecific tissue uptake of imaging agents and limited spatial resolution restrict their usefulness. Magnetic resonance imaging (MRI) and computed tomography (CT) image quality is degraded in the presence of metallic implants due to susceptibility and beam-hardening artifacts, respectively. Although its role is still evolving, FDG-PET imaging will have increased importance in patients with metallic implants used for trauma surgery because FDG uptake is not hampered by metallic artifacts. In contrast to patients with metallic implants, PET may not be as useful in the diagnosis of infection in patients with failed total joint replacements. In this situation, combined 111Indium-labeled leucocyte/(99m)Tc-sulfur colloid marrow imaging still remains the gold standard. This article reviews the currently available literature on FDG-PET and PET/CT in the diagnosis of musculoskeletal infection.