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. 2019 Sep 6;28(3):89-95.
doi: 10.4274/mirt.galenos.2019.20053.

Diagnostic Value of Bone SPECT/CT in Patients with Suspected Osteomyelitis

Pelin Arıcan  1 , Berna Okudan  1 , Rıza Şefizade  1 , Seniha Naldöken  1
Affiliations

Diagnostic Value of Bone SPECT/CT in Patients with Suspected Osteomyelitis

Pelin Arıcan et al. Mol Imaging Radionucl Ther. .

Abstract
in English, Turkish

Objectives: The aim of our retrospective study was to evaluate the contribution of single photon emission computed tomography/computed tomography (SPECT/CT) to three phase bone scintigraphy/SPECT for the assessment of osteomyelitis (OM) and patient’s management.

Methods: Eighty-five patients who were suspected as having OM were included in this study. Tc-99m MDP three phase bone scintigraphy and SPECT/CT were performed to the region of suspected OM. SPECT/CT findings were compared with the findings of planar images/SPECT. Both planar bone scan/SPECT and SPECT/CT findings were divided into two groups: With OM and without OM. In all patients, scintigraphic diagnosis was confirmed by clinical follow up, laboratory findings, microscopic-bacteriological examinations, radiological, surgical, and pathological findings.

Results: SPECT/CT changed the diagnosis and treatment planning in 14/85 (16.5%) patients. SPECT/CT was significantly superior to planar scan/SPECT imaging for determining OM (kappa value was 0.626 for planar scan/SPECT, 0.929 for SPECT/CT). SPECT/CT was statistically more successful in detection of chronic OM, and useful in differentiating chronic OM from acute OM (kappa value was 0.541 for planar scan/SPECT, 0.944 for SPECT/CT).

Conclusion: SPECT/CT increases accuracy of the diagnosis in the evaluation of OM when it is compared to three phase bone scintigraphy/SPECT. SPECT/CT can change the diagnosis and management of the patients.

Amaç: Retrospektif çalışmamızda osteomiyelitin (OM) değerlendirilmesinde ve hasta yönetiminde tek foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi (SPECT/BT) üç fazlı kemik sintigrafisi/SPECT’ye katkısı araştırıldı.

Yöntem: OM’den şüphelenilen 85 hasta çalışmaya dahil edildi. OM şüphesi bulunan bölgeye Tc-99m MDP üç fazlı kemik sintigrafisi ve SPECT/BT yapıldı. SPECT/BT bulguları planar görüntü/SPECT bulguları ile karşılaştırıldı. Planar kemik sintigrafisi/SPECT ve SPECT/BT bulguları iki gruba ayrıldı: OM olmayanlar ve OM olanlar. Tüm hastalarda sintigrafik tanı, klinik takip, laboratuvar, mikroskobik-bakteriyolojik inceleme, radyoloji, cerrahi ve patoloji ile doğrulanmıştır.

Bulgular: SPECT/BT, 14/85 (%16,5) hastada tanı ve tedavi planlamasını değiştirdi. SPECT/BT, OM’nin belirlenmesinde planar görüntüler/SPECT görüntülemeye göre anlamlı derecede üstün bulundu (kappa değeri planar tarama/SPECT için 0,626, SPECT/BT için 0,929). SPECT/BT, kronik OM’nin saptanmasında istatistiksel olarak daha başarılıydı ve akut OM’den kronik OM’nin ayırt edilmesinde faydalı idi (kappa değeri planar tarama/SPECT için 0,541, SPECT/BT için 0,944).

Sonuç: SPECT/BT, üç fazlı kemik sintigrafisi/SPECT ile karşılaştırıldığında OM değerlendirilmesinde tanı doğruluğunu arttırmaktadır. SPECT/BT hastaların teşhis ve yönetimini değiştirebilir.

Keywords: Bone scintigraphy; osteomyelitis; infection; SPECT; SPECT/CT.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Three-phase planar bone scintigraphy of a 41-year-old man with right leg pain and erythema. (A) Blood pool (B) late static images show hyperemia and increased osteoblastic activity in right upper half tibia (arrows). (C) Axial, (D) coronal (E) sagittal computed tomography (CT), single photon emission computed tomography (SPECT) and SPECT/CT images. The heterogeneous increased uptake and chronic morphological changes are seen in the fusion images (arrows). The planar images suggest acute osteomyelitis without SPECT/CT. But chronic osteomyelitis is described with the morphological changes in the CT images. Chronic osteomyelitis is confirmed by pathology
Figure 2
Figure 2
Three-phase PBS of a 56-year-old woman with left foot swelling, pain, and trauma history for 2 years. (A) Perfusion (B) blood pool (C) late static images show slightly increased perfusion, blood pool and osteoblastic activity in left metatarsophalangeal region (arrows). The planar images suggest acute osteomyelitis without single photon emission computed tomography (SPECT)/computed tomography (CT). (D) Axial (E) sagittal CT, and fusion images show fracture site and callus in the distal of second metatarsal bone associated with focal intense increased uptake (arrows). Fracture and callus are confirmed by diagnostic CT
Figure 3
Figure 3
A 18-year-old woman who was operated due to hemifacial atrophy and was being suspected as having osteomyelitis in right mandibula five months after the operation. (A) There is mild hyperemia on the right temporomandibular region in blood pool (B) delayed anterior and right lateral static images show intense focal increased radiotracer uptake in the same area with hyperemia (arrows). (C) Axial and (D) sagittal single photon emission computed tomography/ computed tomography, images show intense focal increased radiotracer uptake around the metal implant on the zygomatic bone (arrows). These findings are interpreted as acute osteomyelitis. The result of microbiological examination is reported as infection
Figure 4
Figure 4
A 22-year-old woman who had right hemiplegia and was suspected as having osteomyelitis in the right upper femur. (A) Blood pool anterior image shows heterogeneous hyperemia in the soft tissues just lateral to the trochanter major (arrows). (B) The intense osteoblastic uptake is seen on trochanteric regions in the anterior late static image. (C) Axial, (D) coronal single photon emission computed tomography (SPECT)/CT images show fistula tract in the soft tissue (white arrows). Fusion images show that radiotracer uptake around the trochanter major is associated with the bone structures within soft tissue (arrows). The findings of SPECT/computed tomography (CT) are described as heterotopic ossification and soft tissue infection. This diagnosis is confirmed by CT and pathology
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