Sathekge, Mike MachabaGarcia‑Perez, OsvaldoPaez, DianaEl‑Haj, NouraKain‑Godoy, TaylorLawal, Ismaheel OpeyemiEstrada‑Lobato, Enrique2019-10-312019-10-312018-01Sathekge, M., Garcia-Perez, O., Paez, D. et al. Molecular imaging in musculoskeletal infections with 99mTc-UBI 29-41 SPECT/CT. Annals of Nuclear Medicine (2018) 32: 54-59. https://doi.org/10.1007/s12149-017-1219-7.0914-7187 (print)1864-6433 (online)10.1007/s12149-017-1219-7http://hdl.handle.net/2263/72081OBJECTIVE : 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.en© The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).99mTc-UBI 29-41SPECT/CTInfectionMusculoskeletalArticle