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

Heng Wu1, Xiao Ma1, Haijian Li1

  • 1Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China.

European Journal of Nuclear Medicine and Molecular Imaging
|November 28, 2025
PubMed
Abstract

Insights

Hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) combined with PET/CT improves chronic osteomyelitis imaging. This advanced technique leads to better surgical outcomes, including reduced recurrence and enhanced recovery.

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.
Keywords:
Bone–soft tissue composite infectionChronic osteomyelitisNeurovascular preservationPET/MRIRecurrence-free survival

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