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Background   18 F-FDG-PET imaging has emerged as a promising method in the diagnosis of chronic osteomyelitis commonly due to  Staphylococcus aureus . The inaccuracy of  18  F-FDG-PET in the detection of periprosthetic joint infections may be related to the predominance of low-virulent  S. epidermidis  strains as the causative pathogen. We have compared the 18 F-FDG-PET characteristics of  S. aureus  osteomyelitis and foreign-body-associated  S. epidermidis  infections under standardized laboratory conditions.    Methods  Twenty-two rabbits were randomized into three groups. In group 1, a localized osteomyelitis model induced with a clinical strain of  S. aureus  was applied. In groups 2 and 3, a foreign-body-associated infection model induced with a clinical or laboratory strain of  S. epidermidis  was applied. A small block of bone cement was surgically introduced into the medullary cavity of the proximal tibia followed by peri-implant injection of  S. aureus  (1 × 10 5  CFU/mL) or one of the two  S. epidermidis  (1 × 10 9  CFU/mL) strains with an adjunct injection of aqueous sodium morrhuate. In group 1, the cement block was surgically removed at 2 weeks but left in place in groups 2 and 3 in order to mimic foreign-body-associated  S. epidermidis  infections. At 8 weeks, the animals were imaged using  18  F-FDG PET/CT. The presence of bacterial infection was confirmed by cultures, and the severity of bone infections was graded by means of radiography, peripheral quantitative CT, and semi-quantitative histology.    Results  The  S. aureus  strain caused constantly culture-positive osteomyelitis. The clinical  S. epidermidis  strain resulted in foreign-body-associated infections, while the laboratory  S. epidermidis  strain (ATCC 35983) induced only occasionally culture-positive infections. There was a correlation ( r  = 0.645;  P  = 0.013) between semi-quantitative score of leukocyte infiltration and the  18  F-FDG uptake in animals with positive cultures. Standardized uptake value (SUV) of the infected bones was twofold ( P  < 0.001) in  S. aureus  animals compared with  S. epidermidis  animals, but there was only a trend ( P  = 0.053, ANOVA) in the differences of the corresponding SUV ratios. This was due to the altered  18  F-FDG uptake of the contralateral tibias probably reflecting a systemic impact of severe osteomyelitis.    Conclusion  The peri-implant inoculation of  S. epidermidis , reflecting low virulence of the pathogen and limited leukocyte infiltration, was characterized by low  18  F-FDG uptake.

ejnmmi research

A comparative 18F-FDG PET/CT imaging of experimental Staphylococcus aureus osteomyelitis and Staphylococcus epidermidis foreign-body-associated infection in the rabbit tibia