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FDG-PET/CT for differentiating between aseptic and septic delayed union in the lower extremity
Kirsten E van Vliet1, Vincent M de Jong2, M Frank Termaat3
1Trauma Unit, Department Surgery, AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. kirsten_van_vliet@hotmail.com.
Archives of Orthopaedic and Trauma Surgery
|September 29, 2017
Summary
18F-fluorodeoxyglucose (18F-FDG) PET/CT can differentiate septic from aseptic delayed unions in the lower extremity. A maximum standardized uptake value (SUVmax) cut-off of 4.0 showed 70% accuracy in this distinction.
Area of Science:
- Nuclear Medicine
- Radiology
- Orthopedics
Background:
- 18F-fluorodeoxyglucose (18F-FDG) PET/CT is accurate for detecting bone infections.
- Differentiating septic from aseptic delayed union is clinically important.
Purpose of the Study:
- To evaluate the efficacy of FDG-PET/CT in differentiating aseptic from septic delayed union.
- To determine the optimal diagnostic accuracy of FDG-PET/CT for this differentiation.
Main Methods:
- Retrospective study of patients with suspected septic delayed union of the lower extremity.
- FDG-PET/CT scans were analyzed for maximum standardized uptake value (SUVmax) at the fracture site.
- Diagnosis was confirmed by surgical deep cultures and clinical follow-up.
Main Results:
- 13 aseptic and 17 septic delayed unions were identified.
- Mean SUVmax was 3.23 ± 1.21 for aseptic and 4.77 ± 1.87 for septic delayed unions.
- An SUVmax cut-off of 4.0 yielded 65% sensitivity, 77% specificity, and 70% accuracy.
Conclusions:
- Semi-quantitative SUVmax measurement in FDG-PET/CT is a promising tool.
- FDG-PET/CT can aid in discriminating between aseptic and septic delayed union.
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