¹⁸F-FDG/PET-CT imaging findings after sternotomy

Area of Science:

• Nuclear Medicine
• Radiology
• Thoracic Surgery

Background:

• Deep sternal wound infection (DSWI) diagnosis relies on imaging, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT).
• Distinguishing post-surgical inflammation from infection on 18F-FDG-PET/CT requires understanding normal imaging findings after sternotomy.

Purpose of the Study:

• To assess normal 18F-FDG-PET/CT imaging findings in non-infected patients following sternotomy.
• To establish a reference for interpreting 18F-FDG uptake in the sternum at various time points post-surgery.

Main Methods:

• Prospective cohort study of non-infected patients who underwent sternotomy.
• 18F-FDG-PET/CT scans performed at 5, 12, and 52 weeks post-surgery.
• Sternal 18F-FDG uptake evaluated visually and quantitatively (SUVmax, SUVmean).

Main Results:

• Sternal uptake significantly decreased from 5 weeks to 52 weeks post-sternotomy (p < 0.01).
• At 5 weeks, all patients showed elevated uptake; by 52 weeks, 55% had no elevated uptake.
• A significant proportion of patients (45% at 52 weeks) still exhibited elevated sternal 18F-FDG uptake patterns.

Conclusions:

• Sternal 18F-FDG uptake diminishes significantly by 52 weeks post-sternotomy.
• Elevated 18F-FDG uptake patterns can persist long-term in non-infected patients, potentially complicating DSWI diagnosis.