Dual time point 2-[18F]fluoro-2′-deoxyglucose positron emission tomography in chronic bacterial ostelomyelitis

Objective Quantitative dual time point imaging with [F-18]fluorodeoxyglucose positron emission tomography (F-18-FDG PET) has recently been found to be more accurate than single time point scanning in the discrimination between benign lesions and malignancy in various conditions. In our study we investigated glucose metabolism in chronic bacterial osteomyelitis (COM) by using F-18-FDG PET and a dual time protocol. Methods Seventeen non-diabetic patients with histopathologically proven COM and four non-diabetic patients with malignant bone disease were prospectively investigated with dual time F-18-FDG PET. All lesions were detected by their increased F-18-FDG uptake 30 and 90 min after injection of 370 MBq of F-18-FDG. The maximum and mean lesional standardized uptake values (SUVmax and SUVmean) after 30 and 90 min were determined. Results The median SUVmax and SUVmean values of all osteomyelitic lesions at 30 min were 1.85 (range, 0.45-3.45) and 1.1 (range, 0.21-1.99), respectively. The median SUVmax and SUVmean values of all malignant lesions at 30 min were 3.19 (range, 2.31-4.7) and 2.82 (range, 2.4-3.71), respectively. At 90 min the median SUVmax and SUVmean of all osteomyelitic lesions were 1.78 (range, 0.4-2.93) and 1.1 (range, 0.18-1.72), respectively. At the same time point the median SUVmax and SUVmean of all malignant lesions were 4.1 (range, 3.52-5.32) and 3.34 (range, 2.81-4.12), respectively. In osteomyelitis the SUVmax and SUVmean between 30 and 90 min post-injection remained stable or decreased in 16/17 patients. In these patients a median decrease of 6% for SUVmax (range, 1-31%) and a median decrease of 8.5% for SUVmean (range, 0-24%) was observed. Changes of SUVmax and SUVmean between 30 and 90 min were highly significant (P < 0.05). In one patient SUVmax and SUVmean increased over the time. The histology of this patient revealed multiple foreign body granulomas in addition to a mononuclear infiltrate. In malignant: lesions the SUVmax and SUVmean between 30 and 90 min post-injection increased. Conclusion Our preliminary results indicate that dynamic dual time point F-18-FDG PET provides a characteristic pattern in chronic osteomyelitis similar to inflammatory processes in other locations. This pattern may be of value in the differentiation between COM and malignant bone lesions. (C) 2004 Lippincott Williams Wilkins.