No bones about it: FDG PET successful in difficult-to-detect chronic osteomyelitis

Molecular imaging aids diagnosis—and developing treatment—for bone and bone marrow infection, report Philadelphia researchers at SNM's 53rd Annual Meeting June 3–7 in San Diego

SAN DIEGO, Calif.--Diagnosing chronic osteomyelitis--a common, serious and often incapacitating infection of bone and bone marrow--in children and adults is often difficult, posing a challenge to physicians. Using positron emission tomography (PET)--with the radiotracer fluorodeoxyglucose (FDG)--"is a highly effective imaging method for determining the presence or absence of chronic osteomyelitis," detailed researchers from the Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia at SNM's 53rd Annual Meeting June 3–7 in San Diego.

"Our findings show that FDG PET should be employed as a study of choice for diagnosing chronic osteomyelitis," said Wichana Chamroonrat, a research fellow at the Hospital of the University of Pennsylvania in Philadelphia. "Recent studies have shown that FDG PET can be used in the evaluation of a variety of inflammatory and infectious processes, and we extended the use of this noninvasive scanning technique in our study," noted the co-author of "FDG-PET Is Highly Accurate for the Diagnosis of Chronic Osteomyelitis."

Osteomyelitis, usually caused by bacteria, occurs most commonly in young children and in older people, but all age groups are at risk, said Chamroonrat. It may be caused by a variety of situations, including an infection from elsewhere in the body, an injury to a bone (an open fracture) or a minor trauma or bacteria in the bloodstream. If osteomyelitis, which affects about two out of every 10,000 people, is not treated successfully, it may develop into chronic osteomyelitis, a persistent, painful infection that is very difficult to eliminate and may lead to loss of bone tissue, said Chamroonrat. "Accurate diagnosis or exclusion of chronic osteomyelitis will substantially decrease the time required for starting appropriate treatments for these patients," said Chamroonrat.

PET is a safe, effective and painless biological imaging exam that is used to detect the presence and extent of cancer, cardiovascular disease, neurological conditions and other physiological problems. Inflammatory cells (white cells) at the site of infected tissue use a large amount of sugar to function and fight the bacteria that caused the disease, said Chamroonrat. The PET radiotracer FDG is similar to a sugar molecule and is taken up by inflammatory cells. "The degree of uptake of FDG usually corresponds to the severity of infection at the site," she said.

FDG PET is used relatively infrequently for detecting infection compared to its widespread applications in cancer management, said Chamroonrat. She indicated that "Our researchers have shown that this powerful imaging modality is very successful in helping patients with a variety of diseases that are caused by bacteria and other organisms," said Chamroonrat. "Our data show that the role of FDG-PET imaging in detecting and characterizing infection and inflammation is quite clear at this time," said Chamroonrat. "However," she continued, "research in our own laboratory as well as in other centers around the world should refine the criteria for optimal utilization of this modality in settings such as diabetic foot, infected prosthesis and other complicated clinical scenarios."

Researchers used FDG-PET imaging with 57 patients with suspected osteomyelitis, comparing scanning images with their final diagnosis based on surgical findings, microbiology and clinical follow-up, noted Chamroonrat. "FDG PET images allowed physicians to correctly diagnose the presence or absence of osteomyelitis in 53 of 57 patients," she said, as well as in 26 of 27 patients with chronic osteomyelitis. FDG PET had a 93 percent accuracy rate in the evaluation of osteomyelitis, she added. Chamroonrat indicated that University of Pennsylvania researchers began studies examining FDG PET and its use with infection and inflammation in the 1990s and especially credited the pioneering work of Hongming Zhuang of Children's Hospital of Philadelphia and Abass Alavi of PENN. These researchers "have taken FDG-PET imaging a step forward by studying its application to patients with chronic osteomyelitis," said Bruce Line, SNM Scientific Program Committee's general clinical specialties vice chair.

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Abstract: H. Zhuang, Children's Hospital of Philadelphia, Philadelphia, Pa., and W. Chamroonrat, M. Houseni, H. Yang and A. Alavi, all with the Hospital of the University of Pennsylvania, Philadelphia, Pa., "FDG PET Is Highly Accurate for the Diagnosis of Chronic Osteomyelitis," SNM's 53rd Annual Meeting, June 3–7, 2006, Scientific Paper 41.

About SNM

SNM is holding its 53rd Annual Meeting June 3–7 at the San Diego Convention Center. Research topics for the 2006 meeting include molecular imaging in clinical practice in the fight against cancer; the role of diagnostic imaging in the management of metastatic bone disease; metabolic imaging for heart disease; neuroendocrine and brain imaging; new agents for imaging infection and inflammation; and an examination of dementia, neurodegeneration, movement disorders and thyroid cancer.

SNM is an international scientific and professional organization of more than 16,000 members dedicated to promoting the science, technology and practical applications of molecular and nuclear imaging to diagnose, manage and treat diseases in women, men and children. Founded more than 50 years ago, SNM continues to provide essential resources for health care practitioners and patients; publish the most prominent peer-reviewed resource in the field; sponsor research grants, fellowships and awards; host the premier annual meeting for medical imaging; and train physicians, technologists, scientists, physicists, chemists and radiopharmacists in state-of-the-art imaging procedures and advances. SNM members have introduced--and continue to explore--biological and technological innovations in medicine that noninvasively investigate the molecular basis of diseases, benefiting countless generations of patients. SNM is based in Reston, Va.; additional information can be found online at http://www.snm.org.


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