Nononcologic Applications of PET/CT and PET/MRI in Musculoskeletal, Orthopedic, and Rheumatologic Imaging: General Considerations, Techniques, and Radiopharmaceuticals

Abstract

Positron Emission Tomography (PET) is often underutilized in the field of musculoskeletal imaging, with key reasons including the excellent performance of conventional musculoskeletal MRI, the limited spatial resolution of PET, and the lack of reimbursement for PET for non-oncologic musculoskeletal indications. However, with improvements in PET/CT and PET/MR imaging over the last decade as well as an increased understanding of the pathophysiology of musculoskeletal diseases, there is an emerging potential for PET as a primary or complementary modality in the management of rheumatologic and orthopedic patients. Specific advantages of PET include the convenience of whole body imaging in a single session, the relative resilience of the modality in the imaging of metallic implants compared to CT and MRI, the ability to evaluate deep joints not amenable to palpation, and the potential for improved specificity of diagnosis with novel radiopharmaceuticals. In this review, we discuss multiple radiopharmaceuticals and technical consideration of PET/CT and PET/MRI that can be employed in imaging of non-tumoral bone and soft tissue disorders. Both PET/CT and PET/MR hold significant promise in the field of musculoskeletal imaging, and with further radiopharmaceutical development and clinical research, these hybrid modalities can potentially transform the current management of patients with orthopedic and rheumatologic disease.

What Is the Best Method to Differentiate Acute Charcot Foot From Acute Infection?

“…14,35 Further interesting developments in aiding in diagnosis are PET-computed tomography (CT) and PETmagnetic resonance (MR), which show promising early results. 4,16,33 Rastogi et al reported the sensitivity and specificity of FDG PET-CT to be 83.3% and 100%, compared with 83.3% and 63.6% for contrast-enhanced MRI for the diagnosis of diabetic foot OM in the background of CN. 33 Previous systemic reviews of the literature (including the International Working Group on the Diabetic Foot's consensus scheme for the diagnosis of diabetic foot OM) and meta-analyses have proposed specific criteria for differentiation of CN from OM.…”

An evaluation of the physiological uptake range of 18F-fluoro-2-deoxy-D-glucose in normal ovaries of seven dogs using positron emission tomography/computed tomography

“…These scans can also be used to visualize non-tumoral bone and soft tissue disorders. This makes it a useful tool for the evaluation of orthopedic and rheumatologic diseases, allowing for more precise diagnosis and treatment planning (16). Furthermore, in neurologic medicine, PET/CT is a sophisticated technique that presents high spatial resolution and integrates functional data with morphological information.…”

Diagnosis and staging of hepatobiliary malignancies: Potential incremental value of (18)F-FDG-PET/MRI compared to MRI of the liver

“…There is a large body of literature demonstrating that PET/MRI is equivalent to PET/CT for staging in many oncologic diseases [8,9] or has only moderate improvement. PET/MRI appears to contribute additional clinically relevant information in scenarios where the strengths of MRI outweigh the limitations of CT in PET/CT [10], for example in the staging of gynaecological cancers [11][12][13], brain neoplasms [14], head and neck cancers [15], soft tissue neoplasms [16] or urological cancers [17]. 18 F-FDG-PET/MRI however has shown to be equivocal or inferior to 18 F-FDG-PET/CT in other malignant disease such as lung cancer, where CT exceeds the morphologic capacities of MRI [18].…”