Evidence-based PET in musculoskeletal infectious and inflammatory diseases.

In 30 seconds

This systematic review assessed original clinical studies of [18F]FDG PET/CT for prosthetic joint infection, diabetic foot infection, spondylodiscitis, osteomyelitis, and rheumatoid arthritis. The search identified 70 studies. Across these conditions, PET/CT showed high sensitivity and negative predictive value, and could outperform or complement conventional imaging in complex or inconclusive cases. Its whole-body imaging also helped identify occult infectious foci. The review notes moderate specificity and variation in acquisition protocols as important constraints; it reports no pooled quantitative estimate of diagnostic performance.

Key findings

• Seventy studies were included, covering five major osteoarticular infectious and inflammatory conditions.
• [18F]FDG PET/CT showed high sensitivity and negative predictive value across the conditions examined.
• Moderate specificity, attributed in part to postoperative or aseptic inflammatory uptake, was a key limitation.
• Semiquantitative measures such as SUVmax correlated with disease activity and treatment response.

Why it matters

The review suggests PET/CT may add diagnostic information when conventional imaging is complex or inconclusive, while whole-body assessment can reveal otherwise occult infectious sites. Its reported sensitivity and negative predictive value may support diagnostic confidence, but moderate specificity and protocol variability mean findings require careful interpretation within the broader clinical assessment.

What to keep in mind

The review identifies moderate specificity related to postoperative or aseptic inflammatory uptake and variability in acquisition protocols. It calls for standardized interpretation criteria and prospective multicenter studies.