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PET/CT Imaging of Infection with FDG

FDG PET/CT has a higher spatial resolution han SPECT. FDG uptake is relatively low in most normal organs, resulting in a relatively high target-to-background ratio.

Osteomyelitis – FDG PET/CT has excellent sensitivity, specificity, and summary ROC for the diagnosis of osteomyelitis. It outperforms skeletal scintigraphy and leukocyte imaging for this indication. (1)

FDG PET/CT has a high accuracy in the setting of chronic osteomyelitis. FDG PET/CT performs similar to MRI for the evaluation of vertebral osteomyelitis and spondylodiscitis. (2)

Diabetic foot infection – FDG PET/CT has been studied in the diabetic foot and it correctly identified 93% of infections as bone versus soft-tissue infections. (3)

Another FDG PET/CT study reported a sensitivity,
specificity, and accuracy of 100%, 92%, and 95% for the diagnosis of diabetic foot osteomyelitis. (4)

Fever of unknown origin – Multiple studies show the
sensitivity and clinical contribution of FDG PET/CT is high with both infectious and noninfectious causes of FUO. FDG PET/CT has the best test performance when compared with gallium scintigraphy and leukocyte scintigraphy. (5)

(1)Comparison of FDG PET/CT and MRI in
the diagnosis of active osteomyelitis; Skeletal Radiology 2014
(2) The diagnos tic value of FDG PET/CT and
MRI in suspected vertebral osteomyelitis; Eur J Nucl Med Mol Imaging 2018
(3) FDG PET/CT imaging in the diagnosis of
osteomyelitis in the diabetic foot; Eur J Nucl Med Mol Imaging 2012
(4) FDG PET for the diagnosis of
osteomyelitis related to diabetic foot; Foot 2013
(5) Nuclear Medicine imaging in fever of
unknown origin: the new paradigm; Curr Pharm Des 2018

Axial views of [18F] FDG PET/CT images (top) and low-dose CT scan (bottom) of a diabetic patient with suspected osteomyelitis of right foot. The scan identified a focal uptake on a cutaneous/subcutaneous ulcer of the soft tissues of plantar surface without bone involvement, thus ruling out the diagnosis of osteomyelitis (courtesy of https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8271312/figure/Fig1/)