Radionuclide Imaging of Musculoskeletal Infection

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 14, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.25
Procedures: 0.25
Head, Spine, and Musculoskeletal: 0.25

Magnetic Resonance Imaging: 0.25
Procedures: 0.25
Musculoskeletal: 0.25

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Other Imaging Procedures: 1.50

Radiography: 0.25
Procedures: 0.25
Extremity Procedures: 0.25

Registered Radiologist Assistant: 0.75
Procedures: 0.75
Musculoskeletal and Endocrine Sections: 0.75

Sonography: 0.25
Procedures: 0.25
Superficial Structures and Other Sonographic Procedures: 0.25

Outline

1. Introduction
2. Morphologic Imaging
   1. Radiography
   2. MRI
   3. CT and Ultrasonography
3. Radionuclide Imaging
   1. Bone Scintigraphy
   2. ⁶⁷Ga Scintigraphy
   3. Labeled Leukocyte Scintigraphy
   4. ¹¹¹In-Biotin
   5. Radiolabeled Antiobiotics
   6. Radiolabeled Antimicrobial Peptides
   7. ¹⁸F-FTG
   8. ¹⁸F-FDG-Labeled Leukocytes
   9. ⁶⁸Ga-Citrate
   10. ¹²⁴I-Fialuridine
4. Indications
   1. Spondylodiskitis
   2. Diabetic Pedal Osteomyelitis
   3. Prosthetic Joint Infection
5. Conclusion

Objectives

Upon completion of this course, students will:

1. identify the systemic risk factors for acute osteomyelitis
2. be familiar with the morphological imaging tests used when suspecting osteomyelitis
3. identify the radiopharmaceutical used for bone scintigraphy
4. be familiar with the appearance of osteomyelitis on a bone scan
5. be familiar with the mechanism of localization of infection with ⁶⁷Ga
6. identify the radionuclides used to label leukocytes in vitro
7. be familiar with the labeling of leukocytes with radionuclides
8. be familiar with the normal distribution of ^99mTc-labeled leukocyte scan
9. identify the radiopharmaceutical used to differentiate infection and marrow
10. identify the in vivo labeled leukocyte imaging agents
11. identify the radiolabeled antimicrobial peptide used for infection imaging
12. be familiar with the categories of musculoskeletal infections
13. be familiar with hematogenously pyogenic spondylodiskitis
14. be familiar with the adjunct role of radionuclide imaging in spondylodiskitis
15. be familiar with the advantages of ⁶⁷Ga SPECT/CT in spondylodiskitis
16. identify radiopharmaceuticals that are useful for diagnosing spondylodiskitis
17. be familiar with the advantages of using SPECT/CT in spondylodiskitis
18. be familiar with the advantages of using ¹⁸F-FDG for low grade spondylodiskitis
19. be familiar with the superiority of ¹⁸F-FDG for localizing sites of infection and guiding minimally invasive surgery
20. be familiar with the limitations of using ¹⁸F-FDG in musculoskeletal infection imaging
21. identify the radionuclide imaging test of choice for diagnosing spondylodiskitis
22. identify the radionuclide imaging test of choice for diagnosing diabetic pedal osteomyelitis
23. be familiar with dual isotope techniques used for diagnosing suspected pedal osteomyelitis
24. be familiar with the development of a Composite Severity Index for ^99mTc-labeled leukocyte SPECT/CT
25. be familiar with the use of ^99mTc-labeled leukocyte SPECT/CT to monitor treatment response in diabetics with pedal osteomyelitis
26. identify the most common cause of prosthetic joint failure
27. identify which imaging modality has become the preeminent evaluation for joint arthroplasty infection
28. be familiar with the radionuclide imaging tests that are best suited for evaluation of joint arthroplasty infection
29. be familiar with the pooled sensitivity and specificity of ¹⁸F-FDG PET and PET/CT for lower extremity prosthetic joint infection
30. be familiar with the hybrid imaging techniques that are redefining the role of radionuclide imaging in patients with musculoskeletal infections