Download PDF
Open Access
CC BY 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/a-2796-6952
Original Cardiovascular

Enhanced Uptake of FDG in PET/CT After the Use of Bone Wax During Sternotomy

Authors

  • Michael Jüptner   ‡‡

    1   Department of Nuclear Medicine, Molecular Diagnostic Imaging and Therapy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

  • Bernd Panholzer    ‡‡

    2   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

  • Anette Friedrichs

    3   Department of Internal Medicine I, Infectious Diseases, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

  • Gregor Warnecke

    2   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

  • Jochen Cremer

    2   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

  • Alexander Thiem

    2   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

  • Ulf Lützen   ‡‡

    1   Department of Nuclear Medicine, Molecular Diagnostic Imaging and Therapy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

  • Jan Schöttler   ‡‡

    2   Department of Cardiac Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Further Information
  Permissions and Reprints All articles of this category

Abstract

Objective

Physiologic healing processes and foreign body reactions can mimic infective conditions in 18F-FDG-PET/CT for the detection of deep sternal wound infections. To date, nothing is known about the metabolic presentation of surgically applied bone wax to the sternum for hemostasis during sternotomy in 18F-FDG-PET/CT imaging. Therefore, this study aims to assess the sternal FDG uptake after the application of bone wax during sternotomy.

Methods

A total of 25 patients with a history of cardiac surgery (1.3–5.5 years ago) were examined by 18F-FDG-PET/CT with dual time point imaging. The sternal FDG uptake was assessed visually (as positive or negative) and metrically using the maximum standardized uptake values (SUVmax) calculated automatically. The SUVmax was compared between the patients with and without the use of bone wax and among patients with and without positive sternal findings in the visual analysis. A correlation analysis was performed between the time since surgery and the sternal SUVmax.

Results

In all eight patients (32%) had received bone wax. In those patients, the mean sternal SUVmax was higher compared to the group without bone wax, both in the early (4.74 ± 1.28 vs. 3.70 ± 1.44; p = 0.0969) and in the late images (6.62 ± 2.67 vs. 4.36 ± 1.44; p = 0.0289). Moreover, the use of bone wax was strongly associated with positive sternal findings in the visual analysis (OR = 10; 95%CI = 0.995–100.462; p = 0.0421). The correlation analysis revealed a slightly decreasing trend without significance (Spearman's ρ = −0.139; p = 0.505).

Conclusion

The use of bone wax during sternotomy could be associated with increased sternal uptake of FDG on 18F-FDG-PET/CT, even several years after surgery. This finding should be considered in the evaluation of potential deep sternal wound infections.

Keywords

FDG - PET/CT - bone wax - hemostasis - sternotomy - inflammation

Contributors' Statement

M.J. contributed to conceptualization, data curation, investigation, writing—original draft; B.P. contributed to conceptualization, methodology, supervision, writing—review and editing; A.F. contributed to supervision, writing—review and editing; G.W. contributed to formal analysis, writing—review and editing; J.T.C. contributed to conceptualization, validation; A.T.: formal analysis, supervision, validation; U.L. contributed to formal analysis, project administration, validation, writing—review and editing; J.S. contributed to conceptualization, formal analysis, validation, writing—review and editing.


‡‡ These authors contributed equally to this article.


‡ These authors share first authorship.




Publication History

Received: 20 August 2025

Accepted: 23 January 2026

Accepted Manuscript online:
28 January 2026

Article published online:
19 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany