Diagnostic value of hybrid FDG-PET/MR imaging of chronic osteomyelitis

D.J.W. Hulsen*, C. Mitea, J.J. Arts, D. Loeffen, J. Geurts

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)


Background Magnetic resonance imaging (MRI) and 2-[F-18]-fluoro-2-deoxy-d-glucose (F-18-FDG) Positron Emission Tomography, paired with Computed Tomography (PET/CT) are commonly used modalities in the complicated diagnostic work-up of osteomyelitis. PET/MRI is a relatively novel hybrid modality with suggested applications in bone infection imaging, based on expert opinion and previous qualitative research. F-18-FDG PET/MRI has the advantages of reduced radiation dose, more soft tissue information, and is deemed more valuable for surgical planning compared to F-18-FDG PET/CT. The goal of this study is to quantitatively assess the diagnostic value of hybrid F-18-FDG PET/MRI for chronic osteomyelitis. Methods A retrospective analysis was performed by a nuclear medicine physician and radiologist on 36 patients with F-18-FDG PET/MRI scans for suspected osteomyelitis. Sensitivity, specificity, and accuracy were determined with the clinical assessment by the orthopaedic surgeon (based on subsequent intraoperative microbiology or long-term follow-up) as the ground truth. Standardized uptake values (SUV) were measured and analysed by means of receiver operating characteristics (ROC). Results This first study to quantitatively report the diagnostic value of F-18-FDG PET/MRI yielded a sensitivity, specificity, and accuracy of 78%, 100%, and 86% respectively. Area under the ROC curve was .736, .755, and .769 for the SUVmax, target to background ratio, and SUVmax_ratio respectively. These results are in the same range and not statistically different compared to diagnostic value for F-18-FDG PET/CT imaging of osteomyelitis in literature. Conclusions Based on the aforementioned advantages of F-18-FDG PET/MRI and the diagnostic value reported here, the authors propose F-18-FDG PET/MRI as an alternative to F-18-FDG PET/CT in osteomyelitis diagnosis, if available.
Original languageEnglish
Article number15
Number of pages16
JournalEuropean Journal of Hybrid Imaging
Issue number1
Publication statusPublished - 1 Aug 2022


  • Osteomyelitis
  • PET
  • MRI
  • Diagnosis
  • Accuracy
  • Standardized uptake values
  • F-18-FDG PET/CT

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