18F-FDG PET/CT as a potential valuable adjunct to MRI in characterising the Brodie's abscess

F Fathinul,Aj Nordin

doi:10.2349/biij.6.3.e26

Abstract

Chronic osteomyelitis (Brodie’s abscess) is essentially a problem of diagnosis, and there may be considerable difficulty in distinguishing it from other benign and malignant bone lesions. Early diagnosis of Brodie’s abscess is deemed important as the disease has a good curative potential following an appropriate antibiotic treatment. Of late, PET/CT using 18F-FDG is taking a centre stage in the imaging of bone infection though documentation on its role in characterising the feature of Brodie’s abscess is exceedingly scarce. On the other hand, it is well known that MRI imaging plays a very important role in distinguishing abscess loculation from malignancy. The authors present the case of a 13-year-old boy with pain in the right heel for few months. Radiograph of the right foot revealed a lucent focus with sclerotic margin in the right calcaneum. MRI T1-weighted images were inconclusive of penumbra sign to characterise abscess cavity due to the small volume lesion. Whole-body 18F-FDG PET/CT scan showed multiple small avid lesions at the margin of the sclerotic rim in the right calcaneum. Final diagnosis of Brodie’s abscess with Klebsiella culture was confirmed via bone debridement.

Highlights

Intensity modulated radiotherapy (IMRT) utilises small beamlets of ionising radiation to provide a highKhamfongkhruea et al Biomed Imaging Interv J 2012; 8(1):e5This page number is not for citation purposes use a respiratory gating system
The measurements by MapCheck show the gamma index of the planned absolute dose distribution in static and moving targets with gating, resulting in more than 96% passing for all dose rates
The absolute dose distribution measured by film for the static target was agreeable with the value of moving target with gating

Summary

Introduction

Intensity modulated radiotherapy (IMRT) utilises small beamlets of ionising radiation to provide a highKhamfongkhruea et al Biomed Imaging Interv J 2012; 8(1):e5This page number is not for citation purposes use a respiratory gating system. Chen et al [5] studied the dosimetric effects caused by the respiratory motion during IMRT by using Kodak EDR2 films. They concluded that, without the gating system, the dose distribution of the stationary phantom was different from the moving one. Duan et al [7] studied the dosimetric effect of respiration-gated beam with IMRT delivery Their results suggested that low dose rate can reduce the effect of delay and catch-up cycle. Lin et al [2] determined the effect of radiation dose rate with moving target and the gated treatment using step-and-shoot IMRT delivery. The high dose rate gated stepand-shoot IMRT was dosimetrically accurate, shortened the delivery time, and was safe to use clinically

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