An untapped potential for imaging of peripheral osteomyelitis in paediatrics using [18F]FDG PET/CT\xa0\u2014the inference from a juvenile porcine model

P Afzelius,A.K.O Alstrup,S B Hansen,O L Nielsen,H C Schønheyder

doi:10.1186/s13550-019-0498-5

P Afzelius, A.K.O Alstrup + Show 3 more

Open Access

https://doi.org/10.1186/s13550-019-0498-5

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Abstract

PurposeTo examine parameters affecting the detection of osteomyelitis (OM) by [18F]FDG PET/CT and to reduce tracer activity in a pig model.Background[18F]FDG PET/CT is recommended for the diagnosis of OM in the axial skeleton of adults. In children, OM has a tendency to become chronic or recurrent, especially in low-income countries. Early diagnosis and initiation of therapy are therefore essential. We have previously demonstrated that [18F]FDG PET/CT is promising in juvenile Staphylococcus aureus (S. aureus) OM of peripheral bones in a pig model, not failing even small lesions. When using imaging in children, radiation exposure should be balanced against fast diagnostics in the individual case.MethodsTwenty juvenile pigs were inoculated with S. aureus. One week after inoculation, the pigs were [18F]FDG PET/CT scanned. PET list-mode acquired data of a subgroup were retrospectively processed in order to simulate and examine the image quality obtainable with an injected activity of 132 MBq, 44 MBq, 13.2 MBq, and 4.4 MBq, respectively.ResultsAll lesions were detected by [18F]FDG PET and CT. Some lesions were very small (0.01 cm3), and others were larger (4.18 cm3). SUVmax was higher when sequesters (p = 0.023) and fistulas were formed (p < 0.0001). The simulated data demonstrated that it was possible to reduce the activity to 4.4 MBq without compromising image quality in pigs.Conclusions[18F]FDG PET/CT localized even small OM lesions in peripheral bones. It was possible to reduce the injected activity considerably without compromising image quality, impacting the applicability of PET/CT in peripheral OM in children.

Highlights

Osteomyelitis (OM) of long bones may be difficult to treat despite advances in operative techniques and treatment with antibiotics, resulting in considerable morbidity, cost, and sometimes even mortality
We have recently demonstrated that [18F]FDG Positron emission tomography (PET) was effective in visualizing OM lesions in the peripheral bones of juvenile pigs [14,15,16]
We focus primarily on ionizing radiation originating from 18F in a juvenile porcine S. aureus OM model, and we simulated different signal-to-noise (SNR) levels in PET images corresponding to various amounts of administered [18F]FDG activity

Summary

Introduction

Osteomyelitis (OM) of long bones may be difficult to treat despite advances in operative techniques and treatment with antibiotics, resulting in considerable morbidity, cost, and sometimes even mortality. The latter is, more likely a problem in low-income countries [1, 2]. The (2019) 9:29 diagnostic methods using radioisotopes (gamma-camera imaging and positron emission tomography (PET)) have the advantages of showing physiology in vivo, as reflected by the uptake of tracers in the body. The techniques are not in competition with each other but complement each other, and by combining modalities like PET and CT, it is possible to acquire both the physiological and the morphological information

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