Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

Abstract

AimsPost-traumatic osteomyelitis (PTO) is difficult to diagnose and there is no consensus on the best imaging strategy. The aim of this study is to present a systematic review of the recent literature on diagnostic imaging of PTO.MethodsA literature search of the EMBASE and PubMed databases of the last 16 years (2000–2016) was performed. Studies that evaluated the accuracy of magnetic resonance imaging (MRI), three-phase bone scintigraphy (TPBS), white blood cell (WBC) or antigranulocyte antibody (AGA) scintigraphy, fluorodeoxyglucose positron emission tomography (FDG-PET) and plain computed tomography (CT) in diagnosing PTO were considered for inclusion. The review was conducted using the PRISMA statement and QUADAS-2 criteria.ResultsThe literature search identified 3358 original records, of which 10 articles could be included in this review. Four of these studies had a comparative design which made it possible to report the results of, in total, 17 patient series. WBC (or AGA) scintigraphy and FDG-PET exhibit good accuracy for diagnosing PTO (sensitivity ranged from 50–100%, specificity ranged from 40–97% versus 83–100% and 51%–100%, respectively). The accuracy of both modalities improved when a hybrid imaging technique (SPECT/CT & FDG-PET/CT) was performed. For FDG-PET/CT, sensitivity ranged between 86 and 94% and specificity between 76 and 100%. For WBC scintigraphy + SPECT/CT, this is 100% and 89–97%, respectively.ConclusionsBased on the best available evidence of the last 16 years, both WBC (or AGA) scintigraphy combined with SPECT/CT or FDG-PET combined with CT have the best diagnostic accuracy for diagnosing peripheral PTO.

Diagnostic accuracy of 99mTc-antigranulocyte SPECT/CT in patients with osteomyelitis and orthopaedic device-related infections: A retrospective analysis

“…In addition to standard diagnostic imaging and microbiological diagnostics, 99m Tc-antigranulocyte SPECT/CT is recommended by current guidelines (Glaudemans et al, 2019) as an alternative to classic radiological techniques such as MRI in the diagnosis of an OM. Current literature reports good sensitivity and specificity (Govaert et al, 2017;Pakos et al, 2007). 99m Tcantigranulocyte SPECT/CT might serve as an alternative diagnostic tool if the patient cannot undergo MRI (e.g., due to MRIincompatible devices).…”

“…Compared to PJI, the preoperative diagnostics are even more limited, as classic aspiration cannot be performed. Despite the use of metal artifact reduction technologies, the diagnostic accuracy of classic crosssectional imaging techniques is often limited and antigranulocyte scintigraphy has superior diagnostic accuracy in patients with posttraumatic or combat-related infections (Govaert et al, 2017;Loessel et al, 2019). Such was also the case in three patients of our cohort (19-21), where cross-sectional imaging with CT and/or MRI showed no sign of infection, but 99m Tc-antigranulocyte SPECT/CT did (Figures 3 and 4) confirmed by intraoperative diagnostics.…”

Hybrid FDG-PET/MR imaging of chronic osteomyelitis: a prospective case series

“…Beside the establishment of the diagnosis, imaging is essential to give information that allows treatment planning by defining the anatomical distribution of the infected or dead bone (Govaert et al 2017). Although the assessment is subjective, the extent of the infection would have been overestimated based on MRI, as compared to PET/MR.…”

“…Assessments were performed twice by the same specialist, at least 2 months apart to improve intra-observer reliability. For every patient, a list of features that the surgeon needs to establish for proper pre-operative planning was assessed (Govaert et al 2017):…”

Metabolic Imaging of Infection

“…The specificity of bone scans drops significantly in violated bones such as after trauma or surgery. Radiolabeled leukocyte imaging either alone or in combination with marrow imaging provides high sensitivity and specificity above 90% for diagnosing skeletal infection in this setting (2,3).…”