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Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement)

  • Luca Maria SconfienzaEmail author
  • Alberto Signore
  • Victor Cassar-Pullicino
  • Maria Adriana Cataldo
  • Olivier Gheysens
  • Olivier Borens
  • Andrej Trampuz
  • Klaus Wörtler
  • Nicola Petrosillo
  • Heinz Winkler
  • Filip M. H. M. Vanhoenacker
  • Paul C. Jutte
  • Andor W. J. M. Glaudemans
Musculoskeletal

Abstract

Objectives

Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement).

Methods and results

After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging.

Conclusions

Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics.

Key Points

• For peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities.

• Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel.

• Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.

Keywords

Osteomyelitis Prosthesis-related infections Clinical laboratory techniques Radiology Nuclear medicine 

Abbreviations

AGA

Anti-granulocyte antibody

CRP

C-reactive protein

CT

Computed tomography

EANM

European Society of Nuclear Medicine

EBJIS

European Bone and Joint Infection Society

ESCMID

European Society of Clinical Microbiology and Infectious Diseases

ESR

Erythrocyte sedimentation rate

ESR

European Society of Radiology

FDG-PET

Fluorodeoxyglucose-positron-emission tomography

HMPAO

Hexamethylpropylene amine oxime

MRI

Magnetic resonance imaging

OCEBM

Oxford Center for Evidence-based Medicine

PBI

Peripheral bone infection

PICO

Population/problem, intervention/indicator, comparator, outcome

PJI

Prosthesis joint infection

SPECT

Single-photon emitting computed tomography

WBC

White blood cell

Notes

Acknowledgements

The original guidelines published on the European Journal of Nuclear Medicine and Molecular Imaging [16, 17] were drafted by the representatives of the respective Scientific Societies: Luca Maria Sconfienza, Victor Cassar-Pullicino, Klaus Wortler, and Filip MHM Vanhoenacker are delegates of the European Society of Radiology (ESR); Andor W.J.M. Glaudemans, Olivier Gheysens, and Alberto Signore are delegates of the European Association of Nuclear Medicine (EANM); Paul C. Jutte, Olivier Borens, and Heinz Winkler are delegates of the European Bone and Joint Infection Society (EBJIS); Nicola Petrosillo, Maria Adriana Cataldo, and Andrej Trampuz are delegates of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Luca Maria Sconfienza.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Not applicable.

Ethical approval

Institutional Review Board approval was not required because this study does not involve patients directly.

Supplementary material

330_2019_6326_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 17 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Luca Maria Sconfienza
    • 1
    • 2
    Email author
  • Alberto Signore
    • 3
  • Victor Cassar-Pullicino
    • 4
  • Maria Adriana Cataldo
    • 5
  • Olivier Gheysens
    • 6
  • Olivier Borens
    • 7
  • Andrej Trampuz
    • 8
  • Klaus Wörtler
    • 9
  • Nicola Petrosillo
    • 5
  • Heinz Winkler
    • 10
  • Filip M. H. M. Vanhoenacker
    • 11
    • 12
    • 13
  • Paul C. Jutte
    • 14
  • Andor W. J. M. Glaudemans
    • 15
  1. 1.IRCCS Istituto Ortopedico GaleazziMilanItaly
  2. 2.Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly
  3. 3.Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine“Sapienza” UniversityRomeItaly
  4. 4.Department of Diagnostic ImagingThe Robert Jones and Agnes Hunt Orthopaedic and District HospitalOswestryUK
  5. 5.Infectious Disease UnitNational Institute for Infectious Diseases “L. Spallanzani”, IRCCSRomeItaly
  6. 6.Department of Nuclear Medicine and Molecular ImagingUniversity Hospitals LeuvenLeuvenBelgium
  7. 7.Division of Orthopaedic Surgery and Traumatology, Septic surgical unitLausanne University Hospital, University of LausanneLausanneSwitzerland
  8. 8.Center for Musculoskeletal Surgery (CMSC)Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  9. 9.Department of Diagnostic and Interventional RadiologyTechnische Universität MünchenMunichGermany
  10. 10.Osteitis-CentrePrivatklinik DöblingViennaAustria
  11. 11.Department of Radiology, Antwerp University Hospital and Antwerp UniversityAntwerpBelgium
  12. 12.AZ Sint-Maarten, BelgiumMechelenBelgium
  13. 13.University of GhentGhentBelgium
  14. 14.Department of Orthopaedic Surgery, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
  15. 15.Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands

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