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Semin Musculoskelet Radiol 2014; 18(02): 194-202
DOI: 10.1055/s-0034-1371020
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

SPECT/CT in Musculoskeletal Infections

Sue Ping Thang
1   Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
,
Aaron Kian Ti Tong
1   Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
,
Winnie Wing Chuen Lam
1   Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
,
David Chee-Eng Ng
1   Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore, Singapore
› Author Affiliations
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Publication History

Publication Date:
08 April 2014 (online)

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Abstract

This article provides a brief overview of the current state of hybrid single-photon emission computed tomography/computer tomography (SPECT/CT) imaging in musculoskeletal infections. SPECT/CT imaging, compared with conventional planar study and SPECT alone, provides improved anatomic localization of infection and more accurate delineation of the extent of infection. This article emphasizes three clinical aspects where SPECT/CT is found to be most useful: differentiating between soft tissue and bone infections, assessing suspected infected sites with underlying structural bone alterations, and defining infective focus when complex anatomy is involved. The accurate assessment of site of infection is vital for selecting the most appropriate therapeutic strategy. Other advantages of SPECT/CT imaging such as reducing the inconvenience of combination planar studies, providing additional CT information, and increasing interobserver agreement are also discussed.

Keywords

SPECT/CT - musculoskeletal - infection
 

  • References

  • 1 Greenspan A, Stadalnik RC. A musculoskeletal radiologist's view of nuclear medicine. Semin Nucl Med 1997; 27 (4) 372-385
    CrossrefPubMedGoogle Scholar
  • 2 Schweitzer ME, Morrison WB. MR imaging of the diabetic foot. Radiol Clin North Am 2004; 42 (1) 61-71 , vi
    CrossrefPubMedGoogle Scholar
  • 3 Santiago Restrepo C, Giménez CR, McCarthy K. Imaging of osteomyelitis and musculoskeletal soft tissue infections: current concepts. Rheum Dis Clin North Am 2003; 29 (1) 89-109
    CrossrefPubMedGoogle Scholar
  • 4 Palestro CJ, Torres MA. Radionuclide imaging in orthopedic infections. Semin Nucl Med 1997; 27 (4) 334-345
    CrossrefPubMedGoogle Scholar
  • 5 Love C, Palestro CJ. Radionuclide imaging of infection. J Nucl Med Technol 2004; 32 (2) 47-57 ; quiz 58–59
    PubMedGoogle Scholar
  • 6 Ledermann HP, Kaim A, Bongartz G, Steinbrich W. Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis. Eur Radiol 2000; 10 (11) 1815-1823
    CrossrefPubMedGoogle Scholar
  • 7 Rennen HJ, Boerman OC, Oyen WJ, Corstens FH. Imaging infection/inflammation in the new millennium. Eur J Nucl Med 2001; 28 (2) 241-252
    CrossrefPubMedGoogle Scholar
  • 8 Becker W, Meller J. The role of nuclear medicine in infection and inflammation. Lancet Infect Dis 2001; 1 (5) 326-333
    CrossrefPubMedGoogle Scholar
  • 9 Weon YC, Yang SO, Choi YY , et al. Use of Tc-99m HMPAO leukocyte scans to evaluate bone infection: incremental value of additional SPECT images. Clin Nucl Med 2000; 25 (7) 519-526
    CrossrefPubMedGoogle Scholar
  • 10 Shreve PD. Adding structure to function. J Nucl Med 2000; 41 (8) 1380-1382
    PubMedGoogle Scholar
  • 11 Schillaci O, Simonetti G. Fusion imaging in nuclear medicine—applications of dual-modality systems in oncology. Cancer Biother Radiopharm 2004; 19 (1) 1-10
    CrossrefPubMedGoogle Scholar
  • 12 Schillaci O. Hybrid SPECT/CT: a new era for SPECT imaging?. Eur J Nucl Med Mol Imaging 2005; 32 (5) 521-524
    CrossrefPubMedGoogle Scholar
  • 13 Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard JP, Liehn JC. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 2009; 76 (5) 474-480
    CrossrefPubMedGoogle Scholar
  • 14 Pineda C, Vargas A, Rodríguez AV. Imaging of osteomyelitis: current concepts. Infect Dis Clin North Am 2006; 20 (4) 789-825
    CrossrefPubMedGoogle Scholar
  • 15 Palestro CJ, Love C, Tronco GG, Tomas MB, Rini JN. Combined labeled leukocyte and technetium 99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection. Radiographics 2006; 26 (3) 859-870
    CrossrefPubMedGoogle Scholar
  • 16 Hoffer P. Gallium: mechanisms. J Nucl Med 1980; 21 (3) 282-285
    PubMedGoogle Scholar
  • 17 Hoffer P. Gallium and infection. J Nucl Med 1980; 21 (5) 484-488
    PubMedGoogle Scholar
  • 18 Aslangul E, M'bemba J, Caillat-Vigneron N , et al. Diagnosing diabetic foot osteomyelitis in patients without signs of soft tissue infection by coupling hybrid 67Ga SPECT/CT with bedside percutaneous bone puncture. Diabetes Care 2013; 36 (8) 2203-2210
    CrossrefPubMedGoogle Scholar
  • 19 Palestro CJ, Tomas MB. Scintigraphic evaluation of the diabetic foot. In: Freeman LM, , ed. Nuclear Medicine Annual. Philadelphia, PA: Lippincott Williams & Wilkins; 2000: 143-172
    Google Scholar
  • 20 Boerman OC, Bleeker-Rovers CP, Rennen HJ, Oyen WJG, Corstens FH. The imaging of infection and inflammation. In: Cook GJR, Maisey MN, Britton KE, Chengazi V, , eds. Clinical Nuclear Medicine. London, UK: Edward Arnold; 2006: 93-106
    Google Scholar
  • 21 Palestro CJ, Kipper SL, Weiland FL, Love C, Tomas MB. Osteomyelitis: diagnosis with (99m)Tc-labeled antigranulocyte antibodies compared with diagnosis with (111)In-labeled leukocytes—initial experience. Radiology 2002; 223 (3) 758-764
    CrossrefPubMedGoogle Scholar
  • 22 Hakim SG, Bruecker CW, Jacobsen HCh , et al. The value of FDG-PET and bone scintigraphy with SPECT in the primary diagnosis and follow-up of patients with chronic osteomyelitis of the mandible. Int J Oral Maxillofac Surg 2006; 35 (9) 809-816
    CrossrefPubMedGoogle Scholar
  • 23 Nadel HR. Bone scan update. Semin Nucl Med 2007; 37 (5) 332-339
    CrossrefPubMedGoogle Scholar
  • 24 Buck AK, Nekolla S, Ziegler S , et al. SPECT/CT. J Nucl Med 2008; 49 (8) 1305-1319
    CrossrefPubMedGoogle Scholar
  • 25 Horger M, Eschmann SM, Pfannenberg C , et al. Added value of SPECT/CT in patients suspected of having bone infection: preliminary results. Arch Orthop Trauma Surg 2007; 127 (3) 211-221
    CrossrefPubMedGoogle Scholar
  • 26 Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. J Nucl Med 2006; 47 (12) 1908-1913
    PubMedGoogle Scholar
  • 27 Bar-Shalom R, Yefremov N, Guralnik L , et al. SPECT/CT using 67Ga and 111In-labeled leukocyte scintigraphy for diagnosis of infection. J Nucl Med 2006; 47 (4) 587-594
    PubMedGoogle Scholar
  • 28 Tumeh SS, Aliabadi P, Weissman BN, McNeil BJ. Disease activity in osteomyelitis: role of radiography. Radiology 1987; 165 (3) 781-784
    CrossrefPubMedGoogle Scholar
  • 29 Seabold JE, Nepola JV, Conrad GR , et al. Detection of osteomyelitis at fracture nonunion sites: comparison of two scintigraphic methods. AJR Am J Roentgenol 1989; 152 (5) 1021-1027
    CrossrefPubMedGoogle Scholar
  • 30 Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med 2009; 39 (1) 66-78
    CrossrefPubMedGoogle Scholar
  • 31 Seabold JE, Nepola JV. Imaging techniques for evaluation of postoperative orthopedic infections. Q J Nucl Med 1999; 43 (1) 21-28
    PubMedGoogle Scholar
  • 32 Love C, Marwin SE, Tomas MB , et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging. J Nucl Med 2004; 45 (11) 1864-1871
    PubMedGoogle Scholar
  • 33 Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med 1990; 31 (12) 1950-1955
    PubMedGoogle Scholar
  • 34 Basu S, Zhuang H, Torigian DA, Rosenbaum J, Chen W, Alavi A. Functional imaging of inflammatory diseases using nuclear medicine techniques. Semin Nucl Med 2009; 39 (2) 124-145
    CrossrefPubMedGoogle Scholar
  • 35 Bessette PR, Hanson MJ, Czarnecki DJ, Yuille DL, Rankin JJ. Evaluation of postoperative osteomyelitis of the sternum comparing CT and dual Tc-99m MDP bone and In-111 WBC SPECT. Clin Nucl Med 1993; 18 (3) 197-202
    CrossrefPubMedGoogle Scholar
  • 36 Seabold JE, Simonson TM, Weber PC , et al. Cranial osteomyelitis: diagnosis and follow-up with In-111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT, and MR imaging. Radiology 1995; 196 (3) 779-788
    CrossrefPubMedGoogle Scholar
  • 37 Van Acker F, Nuyts J, Maes A , et al. FDG-PET, 99mtc-HMPAO white blood cell SPET and bone scintigraphy in the evaluation of painful total knee arthroplasties. Eur J Nucl Med 2001; 28 (10) 1496-1504
    CrossrefPubMedGoogle Scholar
  • 38 Graute V, Feist M, Lehner S , et al. Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results. Eur J Nucl Med Mol Imaging 2010; 37 (9) 1751-1759
    CrossrefPubMedGoogle Scholar
  • 39 Al-Nabhani K, Michopoulou S, Allie R , et al. Painful knee prosthesis: can we help with bone SPECT/CT?. Nucl Med Commun 2014; 35 (2) 182-188
    CrossrefPubMedGoogle Scholar
  • 40 Horger M, Eschmann SM, Pfannenberg C , et al. The value of SPECT/CT in chronic osteomyelitis. Eur J Nucl Med Mol Imaging 2003; 30 (12) 1665-1673
    CrossrefPubMedGoogle Scholar
  • 41 Modic MT, Feiglin DH, Piraino DW , et al. Vertebral osteomyelitis: assessment using MR. Radiology 1985; 157 (1) 157-166
    CrossrefPubMedGoogle Scholar
  • 42 Meyers SP, Wiener SN. Diagnosis of hematogenous pyogenic vertebral osteomyelitis by magnetic resonance imaging. Arch Intern Med 1991; 151 (4) 683-687
    CrossrefPubMedGoogle Scholar
  • 43 Palestro CJ, Kim CK, Swyer AJ, Vallabhajosula S, Goldsmith SJ. Radionuclide diagnosis of vertebral osteomyelitis: indium-111-leukocyte and technetium-99m-methylene diphosphonate bone scintigraphy. J Nucl Med 1991; 32 (10) 1861-1865
    PubMedGoogle Scholar
  • 44 Gemmel F, Dumarey N, Palestro CJ. Radionuclide imaging of spinal infections. Eur J Nucl Med Mol Imaging 2006; 33 (10) 1226-1237
    CrossrefPubMedGoogle Scholar
  • 45 Whalen JL, Brown ML, McLeod R, Fitzgerald Jr RH. Limitations of indium leukocyte imaging for the diagnosis of spine infections. Spine 1991; 16 (2) 193-197
    PubMedGoogle Scholar
  • 46 Even-Sapir E, Flusser G, Lerman H, Lievshitz G, Metser U. SPECT/multislice low-dose CT: a clinically relevant constituent in the imaging algorithm of nononcologic patients referred for bone scintigraphy. J Nucl Med 2007; 48 (2) 319-324
    PubMedGoogle Scholar
  • 47 Love C, Patel M, Lonner BS, Tomas MB, Palestro CJ. Diagnosing spinal osteomyelitis: a comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. Clin Nucl Med 2000; 25 (12) 963-977
    CrossrefPubMedGoogle Scholar
  • 48 Treglia G, Focacci C, Caldarella C , et al. The role of nuclear medicine in the diagnosis of spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16 (Suppl. 02) 20-25
    PubMedGoogle Scholar
  • 49 Livorsi DJ, Daver NG, Atmar RL, Shelburne SA, White Jr AC, Musher DM. Outcomes of treatment for hematogenous Staphylococcus aureus vertebral osteomyelitis in the MRSA ERA. J Infect 2008; 57 (2) 128-131
    CrossrefPubMedGoogle Scholar
  • 50 Lazzeri E, Erba P, Perri M, Doria R, Tascini C, Mariani G. Clinical impact of SPECT/CT with In-111 biotin on the management of patients with suspected spine infection. Clin Nucl Med 2010; 35 (1) 12-17
    CrossrefPubMedGoogle Scholar
  • 51 Lipsky BA, Berendt AR, Deery HG , et al; Infectious Diseases Society of America. Diagnosis and treatment of diabetic foot infections. Plast Reconstr Surg 2006; 117 (7, Suppl): 212S-238S
    CrossrefPubMedGoogle Scholar
  • 52 Becker W. Imaging osteomyelitis and the diabetic foot. Q J Nucl Med 1999; 43 (1) 9-20
    PubMedGoogle Scholar
  • 53 Ledermann HP, Morrison WB, Schweitzer ME. MR image analysis of pedal osteomyelitis: distribution, patterns of spread, and frequency of associated ulceration and septic arthritis. Radiology 2002; 223 (3) 747-755
    CrossrefPubMedGoogle Scholar
  • 54 Devillers A, Moisan A, Hennion F, Garin E, Poirier JY, Bourguet P. Contribution of technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy to the diagnosis of diabetic foot infection. Eur J Nucl Med 1998; 25 (2) 132-138
    CrossrefPubMedGoogle Scholar
  • 55 Schauwecker DS, Park HM, Burt RW, Mock BH, Wellman HN. Combined bone scintigraphy and indium-111 leukocyte scans in neuropathic foot disease. J Nucl Med 1988; 29 (10) 1651-1655
    PubMedGoogle Scholar
  • 56 Filippi L, Uccioli L, Giurato L, Schillaci O. Diabetic foot infection: usefulness of SPECT/CT for 99mTc-HMPAO-labeled leukocyte imaging. J Nucl Med 2009; 50 (7) 1042-1046
    CrossrefPubMedGoogle Scholar
  • 57 Heiba S, Kolker D, Ong L , et al. Dual-isotope SPECT/CT impact on hospitalized patients with suspected diabetic foot infection: saving limbs, lives, and resources. Nucl Med Commun 2013; 34 (9) 877-884
    PubMedGoogle Scholar
  • 58 Heiba SI, Kolker D, Mocherla B , et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg 2010; 49 (6) 529-536
    CrossrefPubMedGoogle Scholar
  • 59 Palestro CJ, Love C. Nuclear medicine and diabetic foot infections. Semin Nucl Med 2009; 39 (1) 52-65
    CrossrefPubMedGoogle Scholar
  • 60 Linke R, Kuwert T, Uder M, Forst R, Wuest W. Skeletal SPECT/CT of the peripheral extremities. AJR Am J Roentgenol 2010; 194 (4) W329-335
    PubMedGoogle Scholar
  • 61 Chakraborty D, Bhattacharya A, Gupta AK, Panda NK, Das A, Mittal BR. Skull base osteomyelitis in otitis externa: The utility of triphasic and single photon emission computed tomography/computed tomography bone scintigraphy. Indian J Nucl Med 2013; 28 (2) 65-69
    CrossrefPubMedGoogle Scholar