SPECT/CT with In111-WBC combined with 99mTc-MDP or 99mTc-sulfur colloid and FDG-PET seem to be the best imaging techniques for diagnosis of bone and joint infections, according to a review published in the January issue of Seminars in Nuclear Medicine.
Wouter van der Bruggen, MD, and colleagues from the department of nuclear medicine at Radboud University Nijmegen Medical Centre, in the Netherlands, reviewed literature on diagnostic accuracy and clinical value of SPECT and PET for imaging of bone and joint infections.
In 44 original articles (15 for SPECT and 29 for 18F-fluorodeoxyglucose [FDG]-PET) on osteomyelitis and prosthetic bone and joint infection, the researchers included 1,634 patients (580 patients SPECT, 1,054 patients FDG-PET).
Van der Bruggen and colleagues found that for SPECT the highest accuracy (95 percent) for diagnosis of bone and joint infections is with combined Indium-labeled white blood cells (In111-WBC) and 99mTc-sulfur colloid. The authors noted that acceptable diagnostic accuracy was also obtained with 99mTc-WBC or 111In-WBC combined with 99mTc-methylene diphosphonate (99mTc-MDP).
“FDG-PET is useful for diagnosis of osteomyelitis with a sensitivity and specificity generally over 95 percent,” the researchers said. The variation in FDG-PET performance in orthopedic implant infections largely depended on the criteria to diagnose infection and sensitivity varied widely from 28 to 91percent and specificity from 9 to 97 percent.
The researchers added, “FDG-PET is also useful for diagnosis of osteomyelitis with improved spatial resolution over SPECT imaging, allowing more accurate localization. Localization can be further improved by adding CT.”
Diagnosis of orthopedic implant infections with FDG-PET depended strongly on the localization of the implant and the criteria used to diagnose infection, according to the study.