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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
F. F. Stecker
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
,
J.-H. Schierz
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
,
T. Opfermann
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
,
D. Driesch
2   BioControl Jena GmbH, Jena, Germany
,
G. O. Hofmann
3   Department of Trauma and Reconstructive Surgery, Bergmannstrost Hospital Halle, Halle (Saale), Germany
4   Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany
,
T. Winkens
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
,
M. Freesmeyer
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
› Author Affiliations
Further Information

Publication History

received: 17 March 2013

accepted in revised form: 10 June 2013

Publication Date:
02 January 2018 (online)

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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 SUVmax, edSUVmean) 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- SUVmax and edSUVmean 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 (edSUVmax, edSUVmean) 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 edSUVmax und edSUVmean 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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