• Arch Orthop Trauma Surg · Feb 2018

    FDG-PET/CT for differentiating between aseptic and septic delayed union in the lower extremity.

    • Kirsten E van Vliet, Vincent M de Jong, M Frank Termaat, Tim Schepers, van Eck-Smit Berthe L F BLF Department of Nuclear Medicine, AMC, Amsterdam, The Netherlands., Goslings J Carel JC Trauma Unit, Department Surgery, AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., and Schep Niels W L NWL Trauma Unit, Department of Surgery, Maasstad ziekenhuis, Rotterdam, The Netherlands..
    • Trauma Unit, Department Surgery, AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. kirsten_van_vliet@hotmail.com.
    • Arch Orthop Trauma Surg. 2018 Feb 1; 138 (2): 189-194.

    Background18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has proven to have a high diagnostic accuracy for the detection of bone infections. In patients with delayed union it may be clinically important to differentiate between aseptic and septic delayed union. The aim of this study was to evaluate the efficacy and to assess the optimal diagnostic accuracy of FDG-PET/CT in differentiating between aseptic and septic delayed union in the lower extremity.MethodsThis is a retrospective study of consecutive patients who underwent FDG-PET/CT scanning for suspicion of septic delayed union of the lower extremity. Diagnosis of aseptic delayed union or septic delayed union was made based on surgical deep cultures following PET/CT scanning and information on clinical follow-up. FDG-uptake values were measured at the fractured site by use of the maximum standardized uptake value (SUVmax). Sensitivity, specificity and diagnostic accuracy of FDG-PET/CT were calculated at various SUVmax cut-off points.ResultsA total of 30 patients were included; 13 patients with aseptic delayed unions and 17 patients with septic delayed unions. Mean SUVmax in aseptic delayed union patients was 3.23 (SD ± 1.21). Mean SUVmax in septic delayed union patients was 4.77 (SD ± 1.87). A cut-off SUVmax set at 4.0 showed sensitivity, specificity and diagnostic accuracy of FDG-PET/CT were 65, 77 and 70% to differentiate between aseptic and septic delayed union, respectively.ConclusionUsing a semi-quantitative measure (SUVmax) for interpretation of FDG-PET/CT imaging seems to be a promising tool for the discrimination between aseptic and septic delayed union.

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