PET/MRI as a complement to PET/CT in chronic osteomyelitis with soft-tissue involvement: implications for surgical...

Area of Science:

• Medical Imaging
• Nuclear Medicine
• Radiology

Background:

• Chronic osteomyelitis with soft-tissue involvement presents significant challenges due to high recurrence and reoperation rates.
• Conventional imaging modalities like [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) have limitations in accurately delineating both bone and soft-tissue infection.
• PET/CT excels in identifying osseous lesions but struggles with soft-tissue detail, while MRI offers soft-tissue visualization but lacks specificity.

Purpose of the Study:

• To evaluate the efficacy of hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) in overcoming the limitations of conventional imaging for chronic osteomyelitis.
• To determine if PET/MRI can improve the surgical management of chronic osteomyelitis with soft-tissue involvement.
• To compare the diagnostic accuracy and clinical outcomes of PET/MRI combined with PET/CT versus standard imaging (PET/CT + MRI).

Main Methods:

• A retrospective review of 52 patients diagnosed with chronic osteomyelitis and soft-tissue infection between 2018 and 2024.
• Patients were divided into two groups: a combined group (PET/CT + PET/MRI, n=10) and a standard group (PET/CT + MRI, n=42).
• Imaging accuracy was assessed against intraoperative findings, with 12-month outcomes including recurrence-free survival (RFS), functional recovery (LEFS, MSTS scores), and neurovascular complications.

Main Results:

• PET/MRI demonstrated superior delineation of soft-tissue infections, including abscesses, sinus tracts, and muscle infiltration, with higher concordance to surgical findings compared to MRI alone.
• The combined PET/CT + PET/MRI group exhibited significantly lower recurrence rates (10.0% vs. 35.7%) and longer RFS compared to the standard group.
• Patients in the combined group showed improved functional recovery (LEFS and MSTS scores) and reduced neurovascular complication rates (10.0% vs. 21.4%).

Conclusions:

• Hybrid PET/MRI, when integrated with PET/CT, enhances the mapping of chronic osteomyelitis infections, facilitating more precise surgical debridement.
• The use of PET/MRI is associated with reduced recurrence rates, improved patient recovery, and better neurovascular safety in complex cases.
• PET/MRI represents a valuable adjunctive tool in the management of chronic osteomyelitis, meriting further investigation in larger prospective studies.