Early dynamic 18F-FDG PET/CT to diagnose chronic osteomyelitis following lower extremity fractures

F. F. Stecker; J.-H. Schierz; T. Opfermann; D. Driesch; G. O. Hofmann; T. Winkens; M. Freesmeyer

doi:10.3413/Nukmed-0572-13-03

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2014; 53(03): 117-122
DOI: 10.3413/Nukmed-0572-13-03

Original article

Schattauer GmbH

Early dynamic ¹⁸F-FDG PET/CT to diagnose chronic osteomyelitis following lower extremity fractures

A pilot studyFrühe dynamische PET/CT-Aufnahmen zur Diagnostik der chronischen Osteomyelitis nach Fraktur der unteren Extremität PilotstudiePilotstudie

Autoren

F. F. Stecker

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
J.-H. Schierz

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
T. Opfermann

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
D. Driesch

²BioControl Jena GmbH, Jena, Germany
G. O. Hofmann

³Department of Trauma and Reconstructive Surgery, Bergmannstrost Hospital Halle, Halle (Saale), Germany

⁴Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
T. Winkens

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
M. Freesmeyer

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

Abstract

Summary

Aim: The study investigates whether early dynamic PET/CT (edPET/CT) using ¹⁸F-fluoro- deoxyglucose (FDG) discriminates between affected versus non-affected sites in patients with complicated, protracted fracture healing and suspected COM in the lower extremities. Patients, methods: In nine consecutive patients (1 woman, 8 men; age 54 ± 13 years), before standard late FDG-PET/CT, altogether 10 edFDG-PET/CT examinations were performed in list mode over 5 min starting with radiopharmaceutical injection. Eight consecutive time intervals (frames), four 15-s, then four 60-s, were reconstructed. For every patient, several volumes-of-interest were selected. To measure early FDG influx and accumulation, maximum and mean ed standardized uptake values (respectively, ed SUV_max, edSUV_mean) were calculated in each volume-of-interest during each frame. Results were compared between affected and non-affected (contralateral) bone. Results: Starting in the 31-45s frame, the affected bone area showed significantly higher ed- SUV_max and edSUV_mean than did the healthy contralateral region. In conventional PET/CT, affected bone areas also significantly differed from non-affected contralateral regions. Conclusion: This pilot study suggests that edFDG- PET may offer a less time consuming add on to standard FDG-PET/CT while being equally accurate. The results should be validated pros- pectively in larger trials.

Zusammenfassung

Ziel: Untersucht wurde, ob mit frühen dynamischen PET/CT-Aufnahmen (edPET/CT) unter Verwendung von ¹⁸F-Fluordesoxyglukose (FDG) bei Patienten mit kompliziertem, verzögertem Heilungsverlauf nach Fraktur der unteren Extremität zwischen betroffener und nicht betroffener Seite unterschieden werden kann. Patienten, Methoden: Bei neun konsekutiven Patienten (1 Frau, 8 Männer; Alter 54 ± 13) wurden vor einer Standard-PET/CT- Untersuchung 10 edPET/CT-Studien über 5 Minuten mittels List-Mode durchgeführt. Es erfolgte die Rekonstruktion von acht konsekutiven Zeitintervallen, vier 15-s und anschließend vier 60-s Intervalle. Zur Quantifizierung der frühen Anflutung und Anreicherung wurden in jedem Zeitintervall der maximale und mittlere ed-standardized uptake value (edSUV_max, edSUV_mean) mit Hilfe von VOI (volume of interest) ermitttelt. Der Vergleich der betroffenen erfolgte mit der nicht betroffenen kontralateralen Extremität. Ergebnisse: Das betroffene Knochenareal zeigte bereits ab dem Zeitintervall 31-45s signifikant höhere edSUV_max und edSUV_mean als die gesunde kontralaterale Seite. Im Standard- PET/CT konnte ebenfalls ein signifikanter Unterschied zwischen betroffener und gesunder Seite festgestellt werden. Schlussfolgerung: Die Ergebnisse dieser Pilotstudie lassen vermuten, dass edPET mit FDG eine schnellere aber ebenso präzise Zusatzuntersuchung zum Standard FDG-PET/CT darstellt. Das Potenzial sollte in einer prospektiven Studie mit größeren Fallzahlen validiert werden.

Keywords

Positron emission tomography - computed tomo graphy - early dynamic positron emission tomography - ¹⁸F-fluorodeoxy glucose - chronic osteomyelitis - diagnosis - list mode

Schlüsselwörter

Positronenemissionstomographie - Computertomographie - frühe dynamische Positronenemissionstomographie - ¹⁸F-Fluordesoxy glukose - chronische Osteomyelitis - Diagnose - List-Mode

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Referenzen

References
1 Bernstine H, Braun M, Yefremov N. et al. FDG PET/CT early dynamic blood flow and late standardized uptake value determination in hepatocellular carcinoma. Radiology 2011; 260: 503-510.
2 Büll U, Schicha H, Biersack H-J. et al. Nuklearmedizin.. Stuttgart: Thieme; 2001
3 El-Maghraby TA, Moustafa HM, Pauwels EK. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. Q J Nucl Med Mol Imaging 2006; 50: 167-192.
4 Freesmeyer M, Lopatta E, Schierz JH. et al. Early dynamic PET imaging shows hypervascularization as exact as contrast-enhanced MR. Nuklearmedizin 2012; 51: N10-N11.
5 Goebel M, Rosa F, Tatsch K. et al. Diagnostik der chronischen Osteitis des Extremitätenskeletts: Stellenwert der ¹⁸F-FDG-PET. Unfallchirurg 2007; 10: 859-866.
6 Gross T, Kaim AH, Regazzoni P, Widmer AF. Current concepts in posttraumatic osteomyelitis: a diagnostic challenge with new imaging options. J Trauma 2002; 52: 1210-1219.
7 Guhlmann A, Brecht-Krauss D, Suger G. et al. Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings. Radiology 1998; 206: 749-754.
8 Hartmann A, Eid K, Dora C. et al. Diagnostic value of ¹⁸F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis. Eur J Nucl Med Mol Imaging 2007; 34: 704-714.
9 Hofmann GO. Infektionen der Knochen und Gelenke.. Urban & Fischer; 2004
10 Kaim A, Ledermann HP, Bongartz G. et al. Chronic post-traumatic osteomyelitis of the lower extremity: comparison of magnetic resonance imaging and combined bone scintigraphy/immunoscintigraphy with radiolabelled monoclonal antigranulocyte antibodies. Skeletal Radiol 2000; 29: 378-386.
11 Lew DP, Waldvogel FA. Osteomyelitis. N Engl J Med 1997; 336: 999-1007.
12 Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: an illustrative review. Radiographics 2003; 23: 341-358.
13 Mader JT, Ortiz M, Calhoun JH. Update on the diagnosis and management of osteomyelitis. Clin Podiatr Med Surg 1996; 13: 701-724.
14 Mullani NA, Herbst RS, O’Neil RG. et al. Tumor blood flow measured by PET dynamic imaging of first-pass ¹⁸F-FDG uptake: a comparison with ¹⁵O-labeled water-measured blood flow. J Nucl Med 2008; 49: 517-523.
15 Pineda C, Vargas A, Rodriguez AV. Imaging of osteomyelitis: current concepts. Infect Dis Clin North Am 2006; 20: 789-825.
16 R DCT. R: A language and environment for statistical computing.. Vienna, Austria: R Foundation for Statistical Computing; 2011
17 Schauwecker DS. The scintigraphic diagnosis of osteomyelitis. AJR Am J Roentgenol 1992; 158: 9-18.
18 Schierz JH, Opfermann T, Steenbeck J. et al. Early Dynamic ¹⁸F-FDG PET to Detect Hyperperfusion in Hepatocellular Carcinoma Liver Lesions. J Nucl Med 2013; 54: 848-854.
19 Schiesser M, Stumpe KD, Trentz O. et al. Detection of metallic implant-associated infections with FDG PET in patients with trauma: correlation with microbiologic results. Radiology 2003; 226: 391-398.
20 Schmidt HG, Tiemann AH, Braunschweig R. et al. Zur Definition der Diagnose Osteomyelitis – Osteomyelitis-Diagnose-Score (ODS). Z Orthop Unfall 2011; 149: 449-460.
21 Termaat MF, Raijmakers PG, Scholten HJ. et al. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87: 2464-2471.
22 Wheat J. Diagnostic strategies in osteomyelitis. Am J Med 1985; 78: 218-224.
23 Zhuang H, Duarte PS, Pourdehand M. et al. Exclusion of chronic osteomyelitis with ¹⁸F fluorodeoxyglucose positron emission tomographic imaging. Clin Nucl Med 2000; 25: 281-284.