Abstract
ObjectiveTo determine the added value of CT over planar and SPECT-only imaging in the diagnosis of musculoskeletal infection using 99mTc-UBI 29-4.Materials and methods184 patients with suspected musculoskeletal infection who underwent planar and SPECT/CT imaging with 99mTc-UBI 29-41 were included. Planar, SPECT-only and SPECT/CT images were reviewed by two independent analysts for presence of bone or soft tissue infection. Final diagnosis was confirmed with tissue cultures, surgery/histology or clinical follow-up.Results99mTc-UBI 29-41 was true positive in 105/184 patients and true negative in 65/184 patients. When differentiating between soft tissue and bone infection, planar + SPECT-only imaging had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 95.0, 74.3, 84.8, 91.3 and 86.9%, respectively, versus 99.0, 94.5, 92.5, 98.5 and 94.5% for SPECT/CT. SPECT/CT resulted in a change in reviewers’ confidence in the final diagnosis in 91/184 patients. Inter-observer agreement was better with SPECT/CT compared with planar + SPECT imaging (kappa 0.87, 95% CI 0.71–0.85 versus kappa 0.81, 95% CI 0.58–0.75).ConclusionAddition of CT to planar and SPECT-only imaging led to an increase in diagnostic performance and an improvement in reviewers’ confidence and inter-observer agreement in differentiating bone from soft tissue infection.
Highlights
The diagnosis and localization of musculoskeletal infection remains a challenge for physicians as infectious diseases can be difficult to detect [1]
When differentiating between soft tissue versus bone infection, combined planar and Single-photon emission computed tomography (SPECT) imaging had a sensitivity of 95.0%, a specificity of 74.3%, 1 3
Osteomyelitis was excluded in 36 patients and the extent of infection was more accurately assessed in 27 patients
Summary
The diagnosis and localization of musculoskeletal infection remains a challenge for physicians as infectious diseases can be difficult to detect [1]. Molecular imaging plays a critical role in the diagnosis of musculoskeletal infections. Radiolabelled leukocyte or white blood cell (WBC) imaging is a common modality for infection diagnosis. Its excellent diagnostic performance has led to it being considered as the gold-standard imaging modality for peripheral bone. Many studies have reported on the use of planar imaging alone [1]. Addition of complementary CT imaging in the form of SPECT/CT has been shown to improve diagnostic accuracy and interpreters’ confidence [3, 4]. CT provides anatomic correlation for the metabolic imaging allowing clear delineation between contiguous structures. The aim of this study was, to assess the added value of CT over planar and SPECT-only in radionuclide imaging of musculoskeletal infection with 99mTc-UBI 29-41
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