FDG-PET in musculoskeletal infections

Area of Science:

• Nuclear Medicine
• Radiology
• Infectious Diseases

Background:

• Musculoskeletal infection diagnosis relies heavily on imaging.
• Conventional radionuclide imaging includes bone, gallium-67, and labeled leukocyte scans.
• FDG-PET (PET/CT) is emerging as a valuable tool for musculoskeletal infection workup.

Purpose of the Study:

• To evaluate the role and efficacy of FDG-PET in diagnosing various musculoskeletal infections.
• To compare FDG-PET performance with conventional radionuclide techniques.
• To identify specific indications where FDG-PET is the preferred imaging modality.

Main Methods:

• Review of existing literature on FDG-PET for musculoskeletal infections.
• Analysis of sensitivity and specificity data for FDG-PET in different infection types.
• Comparison of FDG-PET findings with other imaging modalities like MRI and leukocyte scans.

Main Results:

• FDG-PET offers advantages like precise localization and rapid imaging (hours vs. days).
• High sensitivities (>95%) and specificities (75-99%) reported for acute/subacute bone and soft tissue infections.
• FDG-PET is highly effective for spinal osteomyelitis and differentiating infection from degenerative changes.
• Diagnostic accuracy is less clear for diabetic foot infections and prosthetic joint infections, with limitations in differentiating infection from aseptic loosening.

Conclusions:

• FDG-PET is a powerful tool for diagnosing musculoskeletal infections, particularly spinal osteomyelitis.
• Its utility in prosthetic joint infections is limited compared to leukocyte-marrow imaging.
• Further research is needed to clarify the role of FDG-PET in diabetic foot infections and septic arthritis.