Follow up of acute osteomyelitis in children: The possible role of PET/CT in selected cases

Background: Magnetic Resonance Imaging (MRI) and/or scintigraphy are commonly used for follow up in children after treatment of acute osteomyelitis. Regularly, post treatment imaging reveals pathological findings even if serum inflammatory parameters and clinical presentation are normal. We analyzed combined Positron Emission Tomography and multislice Computed Tomography (PET/CT) for this condition. Methods: Six children received PET/CT after treatment of acute osteomyelitis. Post treatment MRI had revealed suspicious residual and/or additional findings. All patients had physiological serum infection parameters and no clinical symptoms. Results: Median patient age was 59.5 months (48-156). No increased FDG uptake was observed in 3 patients. In 3 patients there was minimal activity at the site of infection, which however did not reach the presumed range of osteomyelitis. All children were taken off antibiotic medication. No clinical symptoms reoccurred in any of them, and repeatedly controlled serum infection parameters were all normal. Median follow up was 33 months (4-65). Conclusions: PET/CT was superior to MRI in distinguishing between infection and reparative activity within the musculoskeletal system in selected children after acute osteomyelitis. The termination of antibiotic treatment in children after acute osteomyelitis seems justified when laboratory parameters as well as clinical presentation are normal, and PET/CT scan is unsuspicious.