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The role of PET in the evaluation of musculoskeletal infections.

Musculoskeletal infections, particularly those in regions of complex anatomy and at postoperative sites, can be difficult to evaluate clinically, yet accurate diagnosis is essential to treat these infections promptly and correctly. Although anatomical imaging modalities are commonly used to diagnose musculoskeletal infections, the application of functional imaging through nuclear medicine techniques has long played a unique and important role in the evaluation of patients with suspected infections. In addition to the standard nuclear medicine single-photon emitting radiotracers traditionally used by nuclear medicine for planar and single-photon emission computed tomography infection imaging, in recent years we have seen a growth in the application of fluorodeoxyglucose (FDG) positron emission tomography (PET) and PET/CT applied to the detection and diagnosis of infection. In this review, we discuss the most common clinical scenarios in which musculoskeletal infection is suspected and for which FDG PET has been studied, in spinal, diabetic foot, and periprosthetic infections. We also highlight recent advances in new non-FDG PET radiotracers that may in the future enable better specificity for and characterization of musculoskeletal infections.