Abstract
PurposeFracture-related infection (FRI) is a complication of surgical fracture treatment and can be challenging to diagnose. Recent studies show promising results for the use of either FDG-PET/CT or WBC/anti-granulocyte scintigraphy. The purpose of this pictorial essay is to outline recent developments in nuclear imaging techniques to diagnose FRI.MethodsThe current literature on this topic is reviewed. Additionally, three examples of patients who underwent nuclear imaging as part of their clinical work-up and surgical treatment for FRI are presented.ResultsBased on recent retrospective studies, FDG-PET/CT (accuracy 0.83) and WBC scintigraphy with SPECT/CT (accuracy 0.92) both have a good diagnostic accuracy for diagnosing fracture-related infection. Nuclear imaging contributes to a correct diagnosis in patients with FRI.ConclusionRetrospective studies show promising results for both FDG-PET/CT and WBC scintigraphy with SPECT/CT in diagnosing FRI. A prospective, multicenter study (IFI trial), directly comparing MRI, FDG-PET/CT, and WBC scintigraphy with SPECT/CT in patients with suspected FRI, is currently in progress.
Highlights
Fracture-related infection (FRI) is a serious complication that may occur after surgical fracture treatment
This study showed a sharp increase in false-positive results in the immediate post-surgical setting (< 4 weeks after fracture fixation), most likely caused by inflammation due to soft-tissue regeneration and bone formation after surgical treatment
Its diagnostic accuracy for FRI appears to be slightly lower, FDG-PET/computed tomography (CT) has several advantages compared to WBC scintigraphy with SPECT/CT
Summary
Fracture-related infection (FRI) is a serious complication that may occur after surgical fracture treatment. The current literature is reviewed, and three clinical cases are presented with several images of both the diagnostic process and surgical treatment Conventional imaging modalities such as radiography and computed tomography (CT) can be used to detect secondary signs of infection such as delayed- or non-union, bone lysis and implant failure (e.g., breakage of plates, nails, or screws). This study showed a sharp increase in false-positive results in the immediate post-surgical setting (< 4 weeks after fracture fixation), most likely caused by inflammation due to soft-tissue regeneration and bone formation after surgical treatment This underlines an important limitation of FDG-PET/CT in the early postsurgical setting. The study protocol for the ‘Imaging in Fracture-related Infection (IFI) study’ was published [19] The inclusion for this prospective, multicenter study started in 2019, and will compare the accuracy of MRI, WBC scintigraphy with SPECT/CT and FDG-PET/CT in patients with suspected FRI. FDG-PET/CT demonstrated increased uptake in and around the non-union site at the proximal femur, which was suspect for an FRI
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