FDG PET detects chronic osteomyelitis

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Diagnosing chronic osteomyelitis—a common, serious and often incapacitating infection of bone and bone marrow—in children and adults is often difficult. But new research shows that using positron emission tomography and fluorodeoxyglucose (FDG) “is a highly effective imaging method for determining the presence or absence of chronic osteomyelitis,” said researchers from the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia this week at SNM’s 53rd Annual Meeting in San Diego.

“Our findings show that FDG PET should be employed as a study of choice for diagnosing chronic osteomyelitis,” said Wichana Chamroonrat, a research fellow at the Hospital of the University of Pennsylvania in Philadelphia. “Recent studies have shown that FDG PET can be used in the evaluation of a variety of inflammatory and infectious processes, and we extended the use of this noninvasive scanning technique in our study,” noted the co-author of “FDG PET Is Highly Accurate for the Diagnosis of Chronic Osteomyelitis.”

Osteomyelitis, usually caused by bacteria, occurs most commonly in young children and in older people, but all age groups are at risk, said Chamroonrat. It may be caused by a variety of situations, including an infection from elsewhere in the body, an injury to a bone (an open fracture) or a minor trauma or bacteria in the bloodstream. If osteomyelitis, which affects about two out of every 10,000 people, is not treated successfully, it may develop into chronic osteomyelitis, a persistent, painful infection that is very difficult to eliminate and may lead to loss of bone tissue, said Chamroonrat. “Accurate diagnosis or exclusion of chronic osteomyelitis will substantially decrease the time required for starting appropriate treatments for these patients,” said Chamroonrat.

FDG PET is used relatively infrequently for detecting infection compared to its widespread applications in cancer management, said Chamroonrat. She indicated that “Our researchers have shown that this powerful imaging modality is very successful in helping patients with a variety of diseases that are caused by bacteria and other organisms,” said Chamroonrat. “Our data show that the role of FDG-PET imaging in detecting and characterizing infection and inflammation is quite clear at this time,” said Chamroonrat. “However,” she continued, “research in our own laboratory as well as in other centers around the world should refine the criteria for optimal utilization of this modality in settings such as diabetic foot, infected prosthesis and other complicated clinical scenarios.”

Researchers used FDG-PET imaging with 57 patients with suspected osteomyelitis, comparing scanning images with their final diagnosis based on surgical findings, microbiology and clinical follow-up, noted Chamroonrat. “FDG-PET images allowed physicians to correctly diagnose the presence or absence of osteomyelitis in 53 of 57 patients,” she said, as well as in 26 of 27 patients with chronic osteomyelitis. FDG PET had a 93 percent accuracy rate in the evaluation of osteomyelitis, she added. Chamroonrat indicated that University of Pennsylvania researchers began studies examining FDG PET and its use with infection and inflammation in the 1990s and especially credited the pioneering work of Hongming Zhuang of Children’s Hospital of Philadelphia and Abass Alavi of Penn.  

Abstract: H. Zhuang, Children's Hospital of Philadelphia, Philadelphia, Pa., and W. Chamroonrat, M. Houseni, H. Yang and A. Alavi, all with the Hospital of the University of Pennsylvania, Philadelphia, Pa., “FDG PET Is Highly Accurate for the Diagnosis of Chronic Osteomyelitis,” SNM’s 53rd Annual Meeting, June 3–7, 2006, Scientific Paper 41.