SPECT and PET in the assessment of bone infections

Abstract

Osteomyelitis or infection of the bone is caused by bacteria, viruses, and fungi. The infection may be localized or may involve periosteum, cortex, marrow, and cancellous tissue. The diagnosis of osteomyelitis can be challenging, and radionuclide procedures routinely are performed as part of the diagnostic work-up. This chapter examines the role of radionuclide imaging in the evaluation of patients with musculoskeletal infections. A review of the uptake mechanisms, as well as the advantages and disadvantages of bone, gallium, labeled leukocyte, and 18F-FDG imaging, is included. The contributions of SPECT and SPECT/CT, as well as PET and PET/CT, also are reviewed. Finally, this chapter provides, through text and illustrations, an in-depth review of the role of nuclear medicine, including SPECT/CT and PET/CT in specific circumstances: the evaluation diabetic foot infections, spinal osteomyelitis/discitis, prosthetic joint infections, and septic arthritis.