Continuing Education on Radionuclide Imaging of Musculoskeletal Infection: A Review

There are numerous imaging tests for diagnosing musculoskeletal infection. Radiographs are routinely performed, because even when not diagnostic, they provide an anatomic overview of the region of interest that could influence subsequent procedure selection and interpretation. Magnetic resonance imaging is sensitive and provides superb anatomic detail. Bone scintigraphy accurately diagnoses osteomyelitis in bones not affected by underlying conditions. Gallium-67 is used primarily for spondylodiscitis. Although invitro labeled leukocyte imaging is the radionuclide test of choice for complicating osteomyelitis such as diabetic pedal osteomyelitis and prosthetic joint infection, it is not useful for spondylodiscitis. Antigranulocyte antibodies and antibody fragments have limitations and are not widely available. 111In-Biotin is useful for spondylodiscitis. Radiolabeled synthetic fragments of the antimicrobial peptide ubiquicidin are promising infection specific agents. Fluorine-18 FDG is the radionuclide test of choice for spondylodiscitis. Its role in diabetic pedal osteomyelitis and prosthetic joint infection is not established. Preliminary data suggest gallium-68 may be useful in musculoskeletal infection. Iodine-124 fialuridine initially showed promise as an infection specific radiopharmaceutical but subsequent investigations were disappointing. The development of positron emission computed tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT) imaging systems, which combine anatomic and functional imaging, has revolutionized diagnostic imaging. These hybrid systems are redefining the diagnostic workup of patients with suspected or known infection and inflammation by improving diagnostic accuracy and influencing patient management. by on October 21, 2017. For personal use only. jnm.snmjournals.org Downloaded from