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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)

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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Fig. 1
Fig. 2

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

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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).

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Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy

    Luca Maria Sconfienza

  2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy

    Luca Maria Sconfienza

  3. Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, “Sapienza” University, Rome, Italy

    Alberto Signore

  4. Department of Diagnostic Imaging, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire, UK

    Victor Cassar-Pullicino

  5. Infectious Disease Unit, National Institute for Infectious Diseases “L. Spallanzani”, IRCCS, Rome, Italy

    Maria Adriana Cataldo & Nicola Petrosillo

  6. Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium

    Olivier Gheysens

  7. Division of Orthopaedic Surgery and Traumatology, Septic surgical unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland

    Olivier Borens

  8. Center for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

    Andrej Trampuz

  9. Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany

    Klaus Wörtler

  10. Osteitis-Centre, Privatklinik Döbling, Vienna, Austria

    Heinz Winkler

  11. Department of Radiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium

    Filip M. H. M. Vanhoenacker

  12. AZ Sint-Maarten, Belgium, Mechelen, Belgium

    Filip M. H. M. Vanhoenacker

  13. University of Ghent, Ghent, Belgium

    Filip M. H. M. Vanhoenacker

  14. Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Paul C. Jutte

  15. Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Andor W. J. M. Glaudemans

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  1. Luca Maria Sconfienza
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Sconfienza, L.M., Signore, A., Cassar-Pullicino, V. et al. Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur Radiol 29, 6425–6438 (2019). https://doi.org/10.1007/s00330-019-06326-1

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