Exclusion of chronic osteomyelitis with F-18 fluorodeoxyglucose positron emission tomographic imaging

Purpose: Excluding the diagnosis of chronic osteomyelitis is often difficul t with noninvasive techniques, especially when bone anatomy and structure h ave been altered by trauma, surgery, or soft-tissue infection. It has been reported that fluorodeoxyglucose (FDG) positron emission tomography (PET) h as excellent potential to diagnose osteomyelitis. In this study, the accura cy of FDG PET in the diagnosis of chronic osteomyelitis was determined. Method: Twenty-two patients with possible osteomyelitis (5 in the tibia, 5 in the spine, 4 in the proximal femur, 4 in the pelvis, 2 in the maxilla, a nd 2 in the feet) who underwent FDG PET imaging and on whom operative or cl inical follow-up data were available were included in this analysis. The fi nal diagnosis was made by surgical exploration or clinical follow-up during a 1-year period. Results: FDG PET correctly diagnosed the presence or absence of chronic ost eomyelitis in 20 of 22 patients. Six had chronic osteomyelitis and 16 prove d to be free of osteomyelitis. FDG PET correctly identified all six patient s with chronic osteomyelitis but produced two false-positive results. This study had a sensitivity rate of 100%, a specificity rate of 87.5%, and an a ccuracy rate of 90.9%. Conclusion: FDG PET is a highly effective imaging method to exclude osteomy elitis when a negative scan result is obtained. However, positive results c an be caused not only by true osteomyelitis but also by inflammation in the bone or surrounding soft tissues as a result of other causes. Overall, FDG PET may prove to be the preferred study in the management of patients with possible chronic osteomyelitis.