OBJECTIVE : To determine the added value of CT over planar and SPECT-only imaging in the diagnosis of musculoskeletal
infection using 99mTc-UBI 29-4.
MATERIALS AND METHODS : 184 patients with suspected musculoskeletal infection who underwent planar and SPECT/CT imaging
with 99mTc-UBI 29-41 were included. Planar, SPECT-only and SPECT/CT images were reviewed by two independent
analysts for presence of bone or soft tissue infection. Final diagnosis was confirmed with tissue cultures, surgery/histology
or clinical follow-up.
RESULTS : 99mTc-UBI 29-41 was true positive in 105/184 patients and true negative in 65/184 patients. When differentiating
between soft tissue and bone infection, planar + SPECT-only imaging had a sensitivity, specificity, positive predictive value,
negative predictive value and accuracy of 95.0, 74.3, 84.8, 91.3 and 86.9%, respectively, versus 99.0, 94.5, 92.5, 98.5 and
94.5% for SPECT/CT. SPECT/CT resulted in a change in reviewers’ confidence in the final diagnosis in 91/184 patients.
Inter-observer agreement was better with SPECT/CT compared with planar + SPECT imaging (kappa 0.87, 95% CI 0.71–0.85
versus kappa 0.81, 95% CI 0.58–0.75).
CONCLUSION : Addition of CT to planar and SPECT-only imaging led to an increase in diagnostic performance and an improvement
in reviewers’ confidence and inter-observer agreement in differentiating bone from soft tissue infection.