TY - JOUR
T1 - 18-Fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan for monitoring the therapeutic response in experimental Staphylococcus aureus foreign-body osteomyelitis
AU - Chatziioannou, Sofia
AU - Papamichos, Odysseas
AU - Gamaletsou, Maria N.
AU - Georgakopoulos, Alexandros
AU - Kostomitsopoulos, Nikolaos G.
AU - Tseleni-Balafouta, Sofia
AU - Papaparaskevas, Joseph
AU - Walsh, Thomas J.
AU - Pneumaticos, Spiros G.
AU - Sipsas, Nikolaos V.
N1 - Publisher Copyright:
© 2015 Chatziioannou et al.
PY - 2015/8/27
Y1 - 2015/8/27
N2 - Background: 18-Fluoro-2-deoxy-d-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) scan is useful for diagnosis of osteoarticular infections. Whether 18F-FDG PET/CT scanning may be used for therapeutic monitoring is not clear. The objective of this study was to develop 18F-FDG PET/CT scanning for monitoring therapeutic response to antimicrobials in experimental Staphylococcus aureus osteomyelitis. Methods: A total of 22 rabbits were studied. In 20 animals, the right tibia was inoculated intraoperatively with S. aureus. Two control animals were inoculated with normal saline. A needle was placed in the tibia as a foreign body. Infection was allowed to develop for 21 days when 18F-FDG PET/CT was performed, the needle was removed, and bone specimens were cultured to confirm infection. Antimicrobial therapy with daptomycin was initiated in all successfully infected animals for 1, 3, or 6 weeks. Following completion of treatment, a second 18F-FDG PET/CT was performed, animals were euthanized, and infected tibias were harvested for quantitative cultures and histology. A positive scan was defined as 18F-FDG signal activity greater in the infected tibia than that of the contralateral non-infected control tibia. Therapeutic response was measured by the change of 18F-FDG signal activity in the infected tibia. Results: All successfully infected animals (n=14), with microbiologically and/or histologically confirmed osteomyelitis, had positive 18F-FDG PET/CT scans, while the two control animals had negative scans despite the presence of the foreign body [mean maximum standardized uptake value (SUVmax) (±SD) values 2.96 (±0.80) vs. 1 (±1.10), respectively, P=0.04]. In the 14 successfully infected animals, the mean SUVmax was significantly higher in the infected compared to the uninfected tibia (P<0.0001). A SUVmax of 1.4, when used as a cutoff for infection, yielded a diagnostic accuracy of 93 %. At the end of treatment, successfully treated animals and saline controls had a negative 18F-FDG PET/CT scan (n=4), while animals with persistent infection despite treatment (n=12) had a positive 18F-FDG PET/CT scan (SUVmax 1.0-3.0) (p<0.001). SUVmax values were significantly reduced after 42 days of treatment from 3.15±0.5 (day 7) to 1.71±0.37 (day 42) (p=0.05). Conclusions:18F-FDG PET/CT scan is a sensitive and specific tool in therapeutic monitoring of experimental foreign-body osteomyelitis.
AB - Background: 18-Fluoro-2-deoxy-d-glucose positron emission tomography combined with computed tomography (18F-FDG PET/CT) scan is useful for diagnosis of osteoarticular infections. Whether 18F-FDG PET/CT scanning may be used for therapeutic monitoring is not clear. The objective of this study was to develop 18F-FDG PET/CT scanning for monitoring therapeutic response to antimicrobials in experimental Staphylococcus aureus osteomyelitis. Methods: A total of 22 rabbits were studied. In 20 animals, the right tibia was inoculated intraoperatively with S. aureus. Two control animals were inoculated with normal saline. A needle was placed in the tibia as a foreign body. Infection was allowed to develop for 21 days when 18F-FDG PET/CT was performed, the needle was removed, and bone specimens were cultured to confirm infection. Antimicrobial therapy with daptomycin was initiated in all successfully infected animals for 1, 3, or 6 weeks. Following completion of treatment, a second 18F-FDG PET/CT was performed, animals were euthanized, and infected tibias were harvested for quantitative cultures and histology. A positive scan was defined as 18F-FDG signal activity greater in the infected tibia than that of the contralateral non-infected control tibia. Therapeutic response was measured by the change of 18F-FDG signal activity in the infected tibia. Results: All successfully infected animals (n=14), with microbiologically and/or histologically confirmed osteomyelitis, had positive 18F-FDG PET/CT scans, while the two control animals had negative scans despite the presence of the foreign body [mean maximum standardized uptake value (SUVmax) (±SD) values 2.96 (±0.80) vs. 1 (±1.10), respectively, P=0.04]. In the 14 successfully infected animals, the mean SUVmax was significantly higher in the infected compared to the uninfected tibia (P<0.0001). A SUVmax of 1.4, when used as a cutoff for infection, yielded a diagnostic accuracy of 93 %. At the end of treatment, successfully treated animals and saline controls had a negative 18F-FDG PET/CT scan (n=4), while animals with persistent infection despite treatment (n=12) had a positive 18F-FDG PET/CT scan (SUVmax 1.0-3.0) (p<0.001). SUVmax values were significantly reduced after 42 days of treatment from 3.15±0.5 (day 7) to 1.71±0.37 (day 42) (p=0.05). Conclusions:18F-FDG PET/CT scan is a sensitive and specific tool in therapeutic monitoring of experimental foreign-body osteomyelitis.
KW - <sup>18</sup>F-FDG PET/CT
KW - Daptomycin
KW - Experimental osteomyelitis
KW - Staphylococcus aureus
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U2 - 10.1186/s13018-015-0274-9
DO - 10.1186/s13018-015-0274-9
M3 - Article
C2 - 26306506
AN - SCOPUS:84940212791
SN - 1749-799X
VL - 10
JO - Journal of Orthopaedic Surgery and Research
JF - Journal of Orthopaedic Surgery and Research
IS - 1
M1 - 132
ER -