Fluorine-18 fluorodeoxyglucose-positron emission tomography: A highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections
F. De Winter et al., Fluorine-18 fluorodeoxyglucose-positron emission tomography: A highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections, J BONE-AM V, 83A(5), 2001, pp. 651-660
Citations number
49
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
Background: The noninvasive diagnosis of chronic musculoskeletal infections
remains a challenge. Recent studies have indicated that fluorine-18 fluoro
deoxyglucose-positron emission tomography is a highly accurate imaging tech
nique and is significantly more accurate than the combination of a bone sca
n and a white blood-cell scan for the diagnosis of chronic infection in the
central skeleton (p < 0.05). However, patients who had had surgery within
the previous two years were excluded from study. It was our aim to evaluate
the technique in an unselected, clinically representative population.
Methods: Sixty patients with a suspected chronic musculoskeletal infection
involving the central skeleton (thirty-three patients) or the peripheral sk
eleton (twenty-seven patients) were studied with fluorine-18 fluorodeoxyglu
cose-positron emission tomography. Thirty-five patients had had surgery wit
hin the previous two years. The fluorine-18 fluorodeoxyglucose-positron emi
ssion tomography studies were read in a blinded, independent manner by two
experienced readers. The final diagnosis was based on histopathological stu
dies or microbiological culture (eighteen patients) or on clinical findings
after at least six months of follow-up (forty-two patients).
Results: On the final composite assessment, twenty-five patients had infect
ion and thirty-five did not. All twenty-five infections were correctly iden
tified by both readers. There were four false-positive findings; in two of
these cases, surgery had been performed less than six months prior to the s
tudy. The sensitivity, specificity, and accuracy were 100%, 88%, and 93% fo
r the whole group; 100%, 90%, and 94% for the subgroup of patients with a s
uspected infection of the central skeleton; and 100%, 86%, and 93% for the
subgroup of patients with a suspected infection of the peripheral skeleton.
Interobserver agreement was excellent (kappa = 0.97).
Conclusions: Fluorine-18 fluorodeoxyglucose-positron emission tomography is
highly accurate as a single technique for the evaluation of chronic muscul
oskeletal infections. It is especially valuable in the evaluation of the ce
ntral skeleton, where white blood-cell scans are less useful. Because of it
s simplicity and high degree of accuracy, it has the potential to become a
standard technique for the diagnosis of chronic musculoskeletal infections.
Further studies are needed to assess its ability to identify infections at
the sites of total joint replacements and to distinguish infection from as
eptic loosening of these prostheses.