Clinical application of dual-phase F-18 sodium-fluoride bone PET/CT for diagnosing surgical site infection following orthopedic surgery

• Published in: Medicine (Baltimore) Vol. 98; no. 11; p. e14770
• Main Authors: Lee, Jeong Won, Yu, Shi Nae, Yoo, Ik Dong, Jeon, Min Hyok, Hong, Chang-Hwa, Shim, Jai-Joon, Chang, Sung-Hae, Lee, Sang Mi
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.03.2019
• Subjects: Adult; Aged; Aged, 80 and over; Diagnostic Accuracy Study; Female; Humans; Male; Middle Aged; Orthopedic Procedures - adverse effects; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies; Surgical Wound Infection - diagnostic imaging; Surgical Wound Infection - etiology
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000014770

F-18 sodium-fluoride (NaF) bone positron emission tomography (PET/CT) has been used for diagnosing various bone and joint diseases, and, with using dual-phase scan protocol, it could give the same information obtained by the 3-phase bone scintigraphy. The present study aimed to evaluate the diagnostic ability of dual-phase F-18 NaF bone PET/CT in detecting surgical site infection after orthopedic surgery.Twenty-three patients who underwent dual-phase F-18 NaF bone PET/CT under clinical suspicion of surgical site infection of the bone following orthopedic surgery were enrolled in this study. Dual-phase bone PET/CT consisted of an early phase scan performed immediately after radiotracer injection and a conventional bone-phase scan. All dual-phase PET/CT images were visually assessed, and, for quantitative analysis, 6 parameters of dual-phase PET/CT (lesion-to-blood pool uptake ratio, lesion-to-bone uptake ratio, and lesion-to-muscle uptake ratio on both early phase and bone-phase scans) were measured.Surgical site infection was diagnosed in 14 patients of the 23 patients. The sensitivity, specificity, and accuracy of visual analysis of dual-phase F-18 NaF bone PET/CT for diagnosing surgical site infection of the bone were 92.9%, 100.0%, and 95.7%, respectively. Among the 6 parameters, the lesion-to-blood pool uptake ratio on early phase scan showed the highest area under the receiver operating characteristic curve value (0.857, 95% confidence interval, 0.649-0.966), with the cut-off value of 0.88 showing sensitivity, specificity, and accuracy of 85.7%, 88.9%, and 87.0%, respectively.Our study showed the high diagnostic ability of dual-phase F-18 NaF bone PET/CT for detecting surgical site infection following orthopedic surgery. Further studies are needed to compare the diagnostic ability of dual-phase bone PET/CT with other imaging modalities.