Published online before print December 11, 2002, 10.1148/radiol.2262011939
Detection of Metallic Implant–associated Infections with FDG PET in Patients with Trauma: Correlation with Microbiologic Results1
Marc Schiesser, MD,
Katrin D. M. Stumpe, MD,
Otmar Trentz, MD,
Thomas Kossmann, MD and
Gustav K. von Schulthess, MD, PhD
1 From the Departments of Surgery, Division of Trauma Surgery (M.S., O.T.) and Medical Radiology, Division of Nuclear Medicine (K.D.M.S., G.K.v.S.), University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Department of Surgery, Division of Trauma Surgery, Monash University, Alfred Hospital, Melbourne, Australia (T.K.). From the 2001 RSNA scientific assembly. Received November 27, 2001; revision requested February 11, 2002; final revision received June 18; accepted June 27. Address correspondence to G.K.v.S. (e-mail: vonschulthess@dmr.usz.ch).
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Figure 1a. Images in a 64-year-old man 8 months after osteosynthesis and muscle flap coverage of a grade 3 open fracture of the left tibia. (a) Coronal FDG PET scan of the distal lower limb shows increased FDG uptake in the course of the muscle flap and osseous activity in the region of one of the distal screws (arrowheads). (b) Anteroposterior conventional radiograph of the distal lower limb shows osteopenia and a suspicious loosened plate (arrowheads) in the distal left tibia. In addition, complete dislocation of one screw is seen. (c) Contrast-enhanced T1-weighted coronal MR image shows multiple artifacts in the left tibia and the surrounding soft tissues (arrows).
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Figure 1b. Images in a 64-year-old man 8 months after osteosynthesis and muscle flap coverage of a grade 3 open fracture of the left tibia. (a) Coronal FDG PET scan of the distal lower limb shows increased FDG uptake in the course of the muscle flap and osseous activity in the region of one of the distal screws (arrowheads). (b) Anteroposterior conventional radiograph of the distal lower limb shows osteopenia and a suspicious loosened plate (arrowheads) in the distal left tibia. In addition, complete dislocation of one screw is seen. (c) Contrast-enhanced T1-weighted coronal MR image shows multiple artifacts in the left tibia and the surrounding soft tissues (arrows).
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Figure 1c. Images in a 64-year-old man 8 months after osteosynthesis and muscle flap coverage of a grade 3 open fracture of the left tibia. (a) Coronal FDG PET scan of the distal lower limb shows increased FDG uptake in the course of the muscle flap and osseous activity in the region of one of the distal screws (arrowheads). (b) Anteroposterior conventional radiograph of the distal lower limb shows osteopenia and a suspicious loosened plate (arrowheads) in the distal left tibia. In addition, complete dislocation of one screw is seen. (c) Contrast-enhanced T1-weighted coronal MR image shows multiple artifacts in the left tibia and the surrounding soft tissues (arrows).
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Figure 2a. Images in a 44-year-old man with a titanium implant in the left tibia after a grade 2 open fracture. (a) Anteroposterior conventional radiograph shows central osteopenia of the distal third of the tibia. (b) Anteroposterior projection of an image obtained at antigranulocyte monoclonal antibody scintigraphy of the feet 6 hours after injection shows activity at the medial side of the left calf (arrows). Compared with PET, in monoclonal antibody scintigraphy, focus localization and differentiation between soft tissue and bone was more difficult. (c) Coronal and (d) transverse PET sections demonstrate intense FDG uptake in the soft tissue (black arrowheads) medial to the osteosynthetic plate of the left calf, as well as linear increased intramedullary uptake (white arrowheads) in the distal left tibia, which corresponds to soft-tissue infection with tibial osteomyelitis.
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Figure 2b. Images in a 44-year-old man with a titanium implant in the left tibia after a grade 2 open fracture. (a) Anteroposterior conventional radiograph shows central osteopenia of the distal third of the tibia. (b) Anteroposterior projection of an image obtained at antigranulocyte monoclonal antibody scintigraphy of the feet 6 hours after injection shows activity at the medial side of the left calf (arrows). Compared with PET, in monoclonal antibody scintigraphy, focus localization and differentiation between soft tissue and bone was more difficult. (c) Coronal and (d) transverse PET sections demonstrate intense FDG uptake in the soft tissue (black arrowheads) medial to the osteosynthetic plate of the left calf, as well as linear increased intramedullary uptake (white arrowheads) in the distal left tibia, which corresponds to soft-tissue infection with tibial osteomyelitis.
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Figure 2c. Images in a 44-year-old man with a titanium implant in the left tibia after a grade 2 open fracture. (a) Anteroposterior conventional radiograph shows central osteopenia of the distal third of the tibia. (b) Anteroposterior projection of an image obtained at antigranulocyte monoclonal antibody scintigraphy of the feet 6 hours after injection shows activity at the medial side of the left calf (arrows). Compared with PET, in monoclonal antibody scintigraphy, focus localization and differentiation between soft tissue and bone was more difficult. (c) Coronal and (d) transverse PET sections demonstrate intense FDG uptake in the soft tissue (black arrowheads) medial to the osteosynthetic plate of the left calf, as well as linear increased intramedullary uptake (white arrowheads) in the distal left tibia, which corresponds to soft-tissue infection with tibial osteomyelitis.
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Figure 2d. Images in a 44-year-old man with a titanium implant in the left tibia after a grade 2 open fracture. (a) Anteroposterior conventional radiograph shows central osteopenia of the distal third of the tibia. (b) Anteroposterior projection of an image obtained at antigranulocyte monoclonal antibody scintigraphy of the feet 6 hours after injection shows activity at the medial side of the left calf (arrows). Compared with PET, in monoclonal antibody scintigraphy, focus localization and differentiation between soft tissue and bone was more difficult. (c) Coronal and (d) transverse PET sections demonstrate intense FDG uptake in the soft tissue (black arrowheads) medial to the osteosynthetic plate of the left calf, as well as linear increased intramedullary uptake (white arrowheads) in the distal left tibia, which corresponds to soft-tissue infection with tibial osteomyelitis.
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Figure 3a. Images in a 75-year old woman 2 years after lumbar decompression and spondylodesis of the lumbar spine, who was suspected of having a low-grade infection. (a) Sagittal coregistered PET-CT scan shows activity (arrow) in the region of the L1-2 intervertebral disk level. (b) Transverse combined PET-CT scan shows increased FDG uptake in the region of the right cranial screw (arrowheads) in the L1 vertebral body. Bone destruction is noted on the CT scan. (c) Transverse combined PET-CT scan shows FDG accumulation cranial to the infected right-sided screw in b (arrowheads).
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Figure 3b. Images in a 75-year old woman 2 years after lumbar decompression and spondylodesis of the lumbar spine, who was suspected of having a low-grade infection. (a) Sagittal coregistered PET-CT scan shows activity (arrow) in the region of the L1-2 intervertebral disk level. (b) Transverse combined PET-CT scan shows increased FDG uptake in the region of the right cranial screw (arrowheads) in the L1 vertebral body. Bone destruction is noted on the CT scan. (c) Transverse combined PET-CT scan shows FDG accumulation cranial to the infected right-sided screw in b (arrowheads).
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Figure 3c. Images in a 75-year old woman 2 years after lumbar decompression and spondylodesis of the lumbar spine, who was suspected of having a low-grade infection. (a) Sagittal coregistered PET-CT scan shows activity (arrow) in the region of the L1-2 intervertebral disk level. (b) Transverse combined PET-CT scan shows increased FDG uptake in the region of the right cranial screw (arrowheads) in the L1 vertebral body. Bone destruction is noted on the CT scan. (c) Transverse combined PET-CT scan shows FDG accumulation cranial to the infected right-sided screw in b (arrowheads).
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Copyright © 2003 by the Radiological Society of North America.
