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Comparison of [18 F]FDG PET/CT and MRI in the diagnosis of active osteomyelitis

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Abstract

Objective

In diagnosing osteomyelitis (OM) both MRI and [18 F]FDG PET-CT proved to be accurate modalities. In anticipation of the advent of hybrid PET/MRI scanners we analyzed our patient group to give direction to future imaging strategies in patients with suspected OM.

Materials and methods

In this retrospective study all patients of a tertiary referral center who underwent both an MRI and a PET for the diagnosis of OM were included. The results of those scans were evaluated using patient’s histology, microbiological findings, and clinical/radiological follow-up. Additionally, ROC curve analysis of the SUVmax and the SUVmax ratio on the PET scans was performed. Two imaging strategies were simulated: first MRI followed by PET, or vice versa.

Results

Twenty-seven localizations in 26 patients were included. Both MRI and PET were shown to be accurate in our patients for the qualitative detection of OM. A cut-off value for the SUVmax of 3 gave optimal results (a specificity of 90 % with a sensitivity of 88 %). The SUVmax ratio gave a worse performance. The two simulated imaging strategies showed no difference in the final diagnosis in 20 out of 27 cases. Remarkably, 6 equivocal cases were all correctly diagnosed by the second modality, i.e., PET or MRI.

Conclusion

Both MRI and [18 F]FDG PET were accurate in diagnosing OM in a tertiary referral hospital population. Simulation of imaging strategies showed that a combined sequential strategy was optimal. It seems preferable to use MRI as a primary imaging tool for uncomplicated unifocal cases, whereas in cases with (possible) multifocal disease or a contraindication for MRI, PET is preferred. This combined sequential strategy looks promising, but needs to be confirmed in a larger prospective study.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital of Maastricht, Maastricht, The Netherlands

    Anastas Demirev, Felix Mottaghy & Boudewijn Brans

  2. Department of Radiology, University Hospital of Maastricht, Maastricht, The Netherlands

    René Weijers

  3. Department of Orthopedic Surgery, University Hospital of Maastricht, Maastricht, The Netherlands

    Jan Geurts & Geert Walenkamp

  4. Department of Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    Boudewijn Brans

Authors
  1. Anastas Demirev
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  2. René Weijers
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  3. Jan Geurts
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  4. Felix Mottaghy
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  5. Geert Walenkamp
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  6. Boudewijn Brans
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Corresponding author

Correspondence to Boudewijn Brans.

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Demirev, A., Weijers, R., Geurts, J. et al. Comparison of [18 F]FDG PET/CT and MRI in the diagnosis of active osteomyelitis. Skeletal Radiol 43, 665–672 (2014). https://doi.org/10.1007/s00256-014-1844-3

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  • DOI: https://doi.org/10.1007/s00256-014-1844-3

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