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Nuclear Medicine Imaging of Peripheral Bone Osteomyelitis and Sternal Wound Infections

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Nuclear Medicine in Infectious Diseases

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Abstract

Infections in the musculoskeletal system are not uncommon and form a serious healthcare problem with high costs, since often young people are involved, and it leads to huge impact on their daily life. Luckily, nuclear medicine techniques are able to help in the diagnostic pathway in patients with suspected peripheral bone infection.

In this book chapter, two serious infections in the skeleton are discussed: the peripheral bone infection (and dissemination of this infection throughout the body by the blood) and the sternal wound infection. The three most commonly used nuclear medicine imaging techniques (three-phase bone scan/NaF-PET, white blood cell scintigraphy with SPECT/CT, and FDG-PET/CT) are discussed: the best way to perform the acquisition and interpretation (according to the EANM guidelines), the pros and cons of each technique, and the position of each technique within the diagnostic pathway.

Furthermore, the different questions of the referring clinician for us as imaging specialists are mentioned, and it is discussed which imaging technique would be best to use for which indication. This is illustrated by an overview of the recently published guidelines by four European Societies on peripheral bone infection, but is also illustrated by several clinical examples.

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References

  1. Renz N, Feihl S, Dlaska CE, Schutz MA, Trampuz A. Osteosynthesis-associated infections: epidemiology, definition and diagnosis. Unfallchirurg. 2017;120(6):454–560.

    Article  CAS  Google Scholar 

  2. Henkelmann R, Frosch KH, Glaab R, Lill H, Schoepp C, Seybold D, Josten C, Hepp P, Committee TotAGASfA, Joint S. Infection following fractures of the proximal tibia—a systematic review of incidence and outcome. BMC Musculoskelet Disord. 2017;18(1):481.

    Article  Google Scholar 

  3. Metsemakers WJ, Handojo K, Reynders P, Sermon A, Vanderschot P, Nijs S. Individual risk factors for deep infection and compromised fracture healing after intramedullary nailing of tibial shaft fractures: a single centre experience of 480 patients. Injury. 2015;46(4):740–5.

    Article  Google Scholar 

  4. Kortram K, Bezstarosti H, Metsemakers WJ, Raschke MJ, Van Lieshout EM, Verhofstad MH. Risk factors for infectious complications after open fractures: a systematic review and meta-analysis. Int Orthop. 2017;41(10):1965–82.

    Article  Google Scholar 

  5. Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFayden I, Scarborough M, Athanasou NA, Ochsner PE, Kuehl R, Raschke M, Borens O, Xie Z, Velkes S, Hungerer S, Kates SL, Zalavras C, Giannoudis PV. Fracture-related infection: a consensus on definition from an international expert group. Injury. 2018;49(3):505–10.

    Article  CAS  Google Scholar 

  6. Govaert GA, IJpma FF, McNally M, McNally E, Reininga IH, Glaudemans AW. Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis—a systematic review of the recent literature. Eur J Nucl Med Mol Imaging. 2017;44:1393–407.

    Article  Google Scholar 

  7. Van den Qyngaert T, Strobel K, Kampen WU, Kuwert T, van der Bruggen W, Mohan HK, et al. The EANM practice guideline for bone scintigraphy. Eur J Nucl Med Mol Imaging. 2016;43:1732–8.

    Google Scholar 

  8. Glaudemans AW, de Vries EF, Vermeulen LE, Slart RH, Dierckx RA, Signore A. A large retrospective single-centre study to define the best image acquisition protocols and interpretation criteria for white blood cell scintigraphy with 99mTc-HMPAO-labelled leukocytes in musculoskeletal infections. Eur J Nucl Med Mol Imaging. 2013;40(11):1760–9.

    Article  Google Scholar 

  9. Erba PA, Glaudemans AW, Veltman NC, Sollini M, Pacilip M, Galli F, et al. Image acquisition and interpretation criteria for 99mTc-HMPAO-labelled white blood cell scintigraphy: results of a multicenter study. Eur J Nucl Med Mol Imaging. 2014;41(4):615–23.

    Article  Google Scholar 

  10. Signore A, Jamar F, Israel O, Buscombe J, Martin-Comin J, Lazzeri E. Clinical indications, image acquisition and data interpretation for white blood cells and anti-granulocyte monoclonal antibody scintigraphy: an EANM procedural guideline. Eur J Nucl Med Mol Imaging. 2018;45(10):1816–31.

    Article  CAS  Google Scholar 

  11. Glaudemans AW, Israel O, Slart RH. Pitfalls and limitations of radionuclide and hybrid imaging in infection and inflammation. Semin Nucl Med. 2015;45(6):500–12.

    Article  Google Scholar 

  12. Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ, et al. EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med. 2013;54(4):647–58.

    Article  Google Scholar 

  13. Grant FD, Fahey FH, Packard AB, Davis RT, Alavi A, Treves ST. Skeletal PET with 18F-fluoride: applying new technology to an old tracer. J Nucl Med. 2008;49(1):68–78.

    Article  Google Scholar 

  14. Ballani NS, Al-Huda FA, Khan HA, Al-Mohannadi S, Mahmood H, Al-Enezi F. The value of quantitative uptake of (99m)Tc-MDP and (99m)Tc-HMPAO white blood cells in detecting osteomyelitis in violated peripheral bones. J Nucl Med Technol. 2007;35(2):91–5.

    Article  CAS  Google Scholar 

  15. Kaim A, Ledermann HP, Bongartz G, Messmer P, Muller-Brand J, Steinbrich W. Chronic post-traumatic osteomyelitis of the lower extremity: comparison of magnetic resonance imaging and combined bone scintigraphy/immunoscintigraphy with radiolabelled monoclonal antigranulocyte antibodies. Skeletal Radiol. 2000;29(7):378–86.

    Article  CAS  Google Scholar 

  16. Meller J, Koster G, Liersch T, Siefker U, Lehmann K, Meyer I, et al. FDG imaging with a dual-head coincidence camera and (111)In-labelled autologous leukocyte scintigraphy. Eur J Nucl Med Mol Imaging. 2002;29(1):53–60.

    Article  CAS  Google Scholar 

  17. Horger M, Eschmann SM, Pfannenberg C, Storek D, Dammann F, Vonthein R, et al. The value of SPET/CT in chronic osteomyelitis. Eur J Nucl Med Mol Imaging. 2003;30(12):1665–73.

    Article  Google Scholar 

  18. Goebel M, Rosa F, Tatsch K, Grillhoesl A, Hofmann GO, Kirschner MH. Diagnosis of chronic osteitis of the bones in the extremities. Relative value of F-18 FDG-PET. Unfallchirurg. 2007;110(10):859–66.

    Article  CAS  Google Scholar 

  19. Hartmann E, Eid K, Dora C, Trentz O, von Schulthess GK, Stumpe KD. Diagnostic value of 18F-FDG PET/CT in trauma patients with suspected chronic osteomyelitis. Eur J Nucl Med Mol Imaging. 2007;34(5):704–14.

    Article  Google Scholar 

  20. Schiesser M, Stumpe KD, Trentz O, Kossmann T, von Schultess GK. Detection of metallic implant-associated infections with FDG PET in patients with trauma: correlation with microbiologic results. Radiology. 2003;226(2):391–8.

    Article  Google Scholar 

  21. Shemesh S, Kosashvili Y, Groshar D, Bernstine H, Sidon E, Cohen N, et al. The value of 18-FDG PET/CT in the diagnosis and management of implant-related infections of the tibia: a case series. Injury. 2015;46(7):1377–82.

    Article  CAS  Google Scholar 

  22. Wenter V, Muller JP, Alberto NL, Lehner S, Fendler WP, Bartenstein P, et al. The diagnostic value of [(18)F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection. Eur J Nucl Med Mol Imaging. 2016;43(4):749–61.

    Article  Google Scholar 

  23. Govaert GA, Bosch P, IJpma FF, Glauche J, Jutte PC, Lemans JV, Wendt KW, Reininga IH, Glaudemans AW. High diagnostic accuracies of white blood cell scintigraphy for fracture related infections: results of a large retrospective single-center study. Injury. 2018;49(6):1085–90.

    Article  CAS  Google Scholar 

  24. Lemans JV, Hobbelink MG, IJpma FF, Plate JD, van den Kieboom J, Bosch P, Leenen PH, Kruyt MC, Glaudemans AW, Govaert GA. The diagnostic accuracy of 18F-FDG PET/CT in diagnosing fracture-related infections. Eur J Nucl Med Mol Imaging. 2019;46(4):999–1008.

    Article  CAS  Google Scholar 

  25. OCEBM Levels of Evidence Working Group. The Oxford 2011 levels of evidence. Oxford Center for Evidence-based Medicine. www.cebm.net/index.aspx?0=5653. Website; 2016.

  26. Glaudemans AW, Jutte PC, Cataldo MA, Cassar-Pullicino V, Gheysens O, Borens O, Trampuz A, Wörtler K, Petrosillo N, Winkler H, Signore A, Sconfienza LM. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging. 2019;46(4):957–70.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Andor W. J. M. Glaudemans

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  1. Andor W. J. M. Glaudemans
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Correspondence to Andor W. J. M. Glaudemans .

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Editors and Affiliations

  1. Nuclear Medicine, Sapienza University of Rome, Rome, Italy

    Alberto Signore

  2. Nuclear Medicine and Molecular Imaging, University of Groningen, Groningen, The Netherlands

    Andor W. J. M. Glaudemans

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Glaudemans, A.W.J.M. (2020). Nuclear Medicine Imaging of Peripheral Bone Osteomyelitis and Sternal Wound Infections. In: Signore, A., Glaudemans, A. (eds) Nuclear Medicine in Infectious Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-25494-0_7

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  • DOI: https://doi.org/10.1007/978-3-030-25494-0_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-25493-3

  • Online ISBN: 978-3-030-25494-0

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