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

Demirev, Anastas; Weijers, R.; Geurts, Jan; Mottaghy, Felix M.; Walenkamp, G. H. I. M.; Brans, Boudewijn

doi:10.1007/s00256-014-1844-3

Cited by 41 publications

(26 citation statements)

References 13 publications

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“…PET/MRI showed additional information that would not have been noticed on PET/CT in one patient. Similar to the findings by Demirev et al, we found that cases where a single modality would have provided an indeterminate assessment, the second modality of the hybrid provided additional information based on which the assessment could be determined (Demirev et al 2014). Discordant findings between the PET image and MR or CT image were observed, as could be expected from the different physical principles of the imaging modalities.…”

Section: Discussionsupporting

confidence: 87%

Hybrid FDG-PET/MR imaging of chronic osteomyelitis: a prospective case series

Hulsen

Geurts

Arts

et al. 2019

European J Hybrid Imaging

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Background: Magnetic resonance imaging (MRI) and 2-[18F]-fluoro-2-deoxy-Dglucose (FDG) positron emission tomography paired with computed tomography (PET/CT) are two commonly used imaging modalities in the complicated diagnostic workup of osteomyelitis. Diagnosis using these modalities relies on, respectively, anatomical (MRI) and metabolic (PET) signs. With hybrid PET/MRI being recently available, our goal is to qualitatively compare hybrid FDG PET/MRI to FDG PET/CT in the diagnosis and operative planning of chronic osteomyelitis. Methods: Five patients with suspected chronic osteomyelitis in an extremity underwent an 18 F-FDG single-injection/dual-imaging protocol with hybrid PET/CT and hybrid PET/MR. Images and clinical features were evaluated using a standardized assessment method. Standardized uptake value (SUV) measurements were performed on all images. Concordant and discordant findings between PET/MRI and PET/CT were analysed. Results: The consensus diagnoses based on PET/MRI and PET/CT images were identical for all five patients. One discrepancy between PET/MRI and PET/CT was found in the assessment of the features in one patient. PET signal intensities and target-tobackground ratios were on average highest for PET/MRI. On PET/MRI, the location of infection based on FDG uptake could clearly be correlated with certain soft tissue structures (oedema, fluid collection, or muscle), which is paramount for surgical planning. Conclusions: In the presented cases, FDG PET/MRI led to the same diagnosis and provided at least the same diagnostic information as PET/CT. PET/MRI was able to provide additional soft-tissue information for the physician planning treatment. Because of this, we suggest that PET/MRI could be used for osteomyelitis diagnosis and treatment planning.

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Section: Discussionsupporting

confidence: 87%

Hybrid FDG-PET/MR imaging of chronic osteomyelitis: a prospective case series

Hulsen

Geurts

Arts

et al. 2019

European J Hybrid Imaging

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“…It is clear that better pathologic and radiologic methods of distinguishing EWS from osteomyelitis are needed to reduce the anxiety of patients and patient guardians and to avoid delays in the management of these diseases. In the future, novel imaging techniques, such as diffusion- weighted MRI, PET-MRI, or the use of tumor-specific radiotracers, may allow us to better distinguish between these distinctly different entities [34]. …”

Section: Discussionmentioning

confidence: 99%

JOURNAL CLUB: Distinguishing Osteomyelitis From Ewing Sarcoma on Radiography and MRI

McCarville

Chen

Coleman

et al. 2015

American Journal of Roentgenology

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OBJECTIVE The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases. MATERIALS AND METHODS Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined. RESULTS On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ≤ 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ≤ 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ≤ 0.01). The findings from 100% of open biopsies (18/18) and 58% of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88% of open biopsies (22/25) and 50% of percutaneous biopsies (3/6) resulted in a diagnosis of EWS. CONCLUSION Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic accuracy. Compared with percutaneous biopsy, open biopsy provides a higher diagnostic yield but may be inconclusive, especially for cases of EWS. Our findings underscore the need for better methods of diagnosing these disease processes.

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“…FDG PET can be used to differentiate between active inflammation and degenerative changes seen on MRI, thereby improving specificity. In a retrospective study of patients who underwent both MRI and FDG PET for a suspected diagnosis of osteomyelitis, a simulated imaging strategy showed that if PET or MRI was equivocal for osteomyelitis, the addition of the other modality resulted in the correct diagnosis . Furthermore, recent work showed that simultaneous FDG PET‐MRI significantly increased diagnostic certainty for detection of spondylodiscitis in patients with inconclusive clinical or MRI findings (Fig.…”

Section: Osteoporosis and Metabolic Bone Diseasesmentioning

confidence: 99%