Optimizing Surgical Planning Using 18F-FDG PET-CT in Appendicular Chronic Osteomyelitis: Insights from 84 Patient...

Area of Science:

• Orthopedics
• Nuclear Medicine
• Radiology

Background:

• Chronic osteomyelitis presents significant surgical management challenges.
• Accurate determination of infection extent is crucial for effective treatment.
• 18F-FDG PET/CT is explored as a preoperative planning tool.

Purpose of the Study:

• To evaluate the utility of 18F-FDG PET/CT in preoperative planning for chronic osteomyelitis.
• To assess the impact of PET/CT guided debridement on clinical outcomes.
• To determine the recurrence rate after surgical management guided by PET/CT.

Main Methods:

• Retrospective analysis of prospectively collected data from 84 patients with chronic osteomyelitis.
• All patients underwent 18F-FDG PET/CT imaging prior to surgical debridement.
• Surgical debridement was guided by PET/CT findings, with a minimum 1-year follow-up.

Main Results:

• 18F-FDG PET/CT accurately identified resection margins, soft tissue collections (23.8%), and sequestrum (67.9%).
• The mean SUVmax was significantly higher at infection sites (6.69) compared to the contralateral limb (1.45).
• A high success rate of 96.4% was achieved, with only 3.6% recurrence within the first year.

Conclusions:

• 18F-FDG PET/CT integration enhances surgical planning for chronic osteomyelitis.
• This imaging modality improves outcomes and reduces infection recurrence rates.
• PET/CT is valuable for delineating infection extent, unaffected by metal implants.