Analysis of specimens collected from highest and lowest uptake areas according to F18- FDG PET-CT in chronic osteomyelitis

Elsheikh, Ahmed A.; Ahmad, Abdel-salam A.; Elgendi, Mohamed Ahmed; Giotakis, Nikolaos; Hosny, Gamal Ahmed

doi:10.21608/bmfj.2023.212490.1821

Analysis of specimens collected from highest and lowest uptake areas according to F18- FDG PET-CT in chronic osteomyelitis

Articles in Press

Document Type : Original Article

Authors

¹ lecturer of Orthopedic Surgery Faculty of Medicine Benha University

² Orthopedic department, faculty of medicine, Benha university

³ Orthopedic surgery resident, Ahmed Maher Teaching Hospital

⁴ Consultant orthopaedic and truma surgeon, LIVERPOOL UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

⁵ Orthopedic department, faculty of medicine , benha university

10.21608/bmfj.2023.212490.1821

Abstract

Purpose:The purpose of study was to evaluate the microbiological and histopathological findings of samples taken from the highest uptake areas (HUA) and the lowest uptake areas (LUA) of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in cases of fracture-related chronic osteomyelitis (COM). Patients and Methods: This prospective study included 14 males with a mean age of 44.2 years having fracture-related COM. The maximum standardised uptake value (SUVmax) was recorded in the axial cuts of PET/CT. Separate deep surgical samples were taken from HUA and LUA areas. Samples were subjected for microbiological (three to four samples) and histopathological (one additional sample) examination. Results: The affected bones had sinuses draining pus and included eight tibiae, four femora, one fibula, and one ulna. The mean injury-to-infection duration was 6.1 months. The mean infection duration was 15.9 months. The mean number of previous surgeries was 3.4 procedures. Eleven fractures were non-united. SUVmax in HUA (mean 9.9) was significantly higher than SUVmax in LUA (mean 3.9). All histopathological samples revealed active COM. Microbiological findings revealed Gram-positive (42.9%), Gram-negative (28.6%), and both Gram-positive and negative (28.6%) organisms. Bacterial cultures were different between HUA and LUA in seven patients including six cases with no growth in LUA. Three cases had same pathogen with one added organism in one area. Conclusion: The variability of isolated bacteria highlights the critical value of collecting samples from both HUA and LUA because one area may have different and/or additional pathogens necessitating changes in the antibiotic plan for better COM treatment.

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