PET/CT and SPECT/CT for Infection in Joints and Bones: An Overview and Future Directions

IF 4.6 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Seminars in nuclear medicine Pub Date : 2024-05-01 DOI:10.1053/j.semnuclmed.2023.10.007
Kgomotso M.G. Mokoala MD, PhD , Honest Ndlovu MD , Ismaheel Lawal MD, PhD , Mike Machaba Sathekge MD, PhD
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Abstract

Infections of the bones and joints, if misdiagnosed, may result in serious morbidity and even mortality. A prompt diagnosis followed by appropriate management may reduce the socioeconomic impact of bone and joint infections. Morphologic imaging such as ultrasound and plain radiographs form the first line investigations, however, in early infections findings may be negative or nonspecific. Nuclear medicine imaging techniques play a complementary role to morphologic imaging in the diagnosis of bone and joint infections. The availability of hybrid systems (SPECT/CT, SPECT/MRI, PET/CT or PET/MRI) offers improved specificity with ability to assess the extent of infection. Bone scans are useful as a gatekeeper wherein negative scans rule out sepsis with a good accuracy, however positive scans are nondiagnostic and more specific tracers should be considered. These include the use of labeled white blood cells and antigranulocyte antibodies. Various qualitative and quantitative interpretation criteria have been suggested to improve the specificity of the scans. PET has better image resolution and 18F-FDG is the major tracer for PET imaging with applications in oncology and inflammatory/infective disorders. It has demonstrated improved sensitivity over the SPECT based tracers, however, still suffers from lack of specificity. 18F-FDG PET has been used to monitor therapy in bone and joint infections. Other less studied, noncommercialized SPECT and PET tracers such as 111In-Biotin, 99mTc-Ubiquicidin, 18F-Na-Fluoride, 18F-labeled white blood cells and 124I-Fialuridine to name a few have shown great promise, however, their role in various bone and joint infections has not been established. Hybrid imaging with PET or PET/MRI offers huge potential for improving diagnostics in infections of the joints and bones.

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PET/CT和SPECT/CT用于关节和骨骼感染:综述和未来方向。
骨骼和关节的感染,如果误诊,可能会导致严重的发病率甚至死亡。及时诊断和适当处理可以减少骨和关节感染的社会经济影响。形态学成像如超声和x线平片是一线检查,然而,早期感染的发现可能是阴性或非特异性的。核医学成像技术在骨和关节感染的诊断中与形态学成像具有互补作用。混合系统(SPECT/CT, SPECT/MRI, PET/CT或PET/MRI)的可用性提高了评估感染程度的特异性。骨扫描作为一个看门人是有用的,其中阴性扫描以良好的准确性排除败血症,然而阳性扫描是非诊断性的,应该考虑更具体的示踪剂。这些包括使用标记白细胞和抗粒细胞抗体。已经提出了各种定性和定量解释标准,以提高扫描的特异性。PET具有更好的图像分辨率,18F-FDG是PET成像的主要示踪剂,在肿瘤学和炎症/感染性疾病中有应用。与基于SPECT的示踪剂相比,它已经证明了更高的灵敏度,然而,它仍然缺乏特异性。18F-FDG PET已被用于监测骨和关节感染的治疗。其他研究较少、未商业化的SPECT和PET示踪剂,如111in -生物素、99mtc -泛素、18f - na -氟化物、18f标记的白细胞和124I-Fialuridine等,已显示出很大的前景,然而,它们在各种骨骼和关节感染中的作用尚未确定。PET或PET/MRI混合成像为改善关节和骨骼感染的诊断提供了巨大的潜力。
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来源期刊
Seminars in nuclear medicine
Seminars in nuclear medicine 医学-核医学
CiteScore
9.80
自引率
6.10%
发文量
86
审稿时长
14 days
期刊介绍: Seminars in Nuclear Medicine is the leading review journal in nuclear medicine. Each issue brings you expert reviews and commentary on a single topic as selected by the Editors. The journal contains extensive coverage of the field of nuclear medicine, including PET, SPECT, and other molecular imaging studies, and related imaging studies. Full-color illustrations are used throughout to highlight important findings. Seminars is included in PubMed/Medline, Thomson/ISI, and other major scientific indexes.
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