@article {5144,
	title = {18-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan for monitoring the therapeutic response in experimental Staphylococcus aureus foreign-body osteomyelitis.},
	journal = {J Orthop Surg Res},
	volume = {10},
	year = {2015},
	month = {2015},
	pages = {132},
	abstract = {BACKGROUND: 18-Fluoro-2-deoxy-D-glucose positron emission tomography combined with computed tomography ((18)F-FDG PET/CT) scan is useful for diagnosis of osteoarticular infections. Whether (18)F-FDG PET/CT scanning may be used for therapeutic monitoring is not clear. The objective of this study was to develop (18)F-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 (18)F-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 (18)F-FDG PET/CT was performed, animals were euthanized, and infected tibias were harvested for quantitative cultures and histology. A positive scan was defined as (18)F-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 (18)F-FDG signal activity in the infected tibia.

RESULTS: All successfully infected animals (n = 14), with microbiologically and/or histologically confirmed osteomyelitis, had positive (18)F-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) ({\textpm}SD) values 2.96 ({\textpm}0.80) vs. 1 ({\textpm}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 (18)F-FDG PET/CT scan (n = 4), while animals with persistent infection despite treatment (n = 12) had a positive (18)F-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 {\textpm} 0.5 (day 7) to 1.71 {\textpm} 0.37 (day 42) (p = 0.05).

CONCLUSIONS: (18)F-FDG PET/CT scan is a sensitive and specific tool in therapeutic monitoring of experimental foreign-body osteomyelitis.},
	issn = {1749-799X},
	doi = {10.1186/s13018-015-0274-9},
	author = {Chatziioannou, Sofia and Papamichos, Odysseas and Gamaletsou, Maria N and Georgakopoulos, Alexandros and Kostomitsopoulos, Nikolaos G and Tseleni-Balafouta, Sofia and Papaparaskevas, Joseph and Walsh, Thomas J and Pneumaticos, Spiros G and Sipsas, Nikolaos V}
}
