{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:45:15Z","timestamp":1790167515865,"version":"4.1.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T00:00:00Z","timestamp":1758326400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T00:00:00Z","timestamp":1758326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Nucl Med Mol Imaging"],"published-print":{"date-parts":[[2026,2]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Standard [\n 18<\/jats:sup>\n F]FDG PET\/CT is widely used to detect infections, but is limited in differentiating bacterial infection from inflammation due to overlapping uptake patterns. This distinction is particularly challenging in fracture-related infection (FRI), due to multiple factors, including recent surgery, soft tissue injury, fracture healing, and surgical implants. Dynamic [\n 18<\/jats:sup>\n F]FDG imaging over time may overcome this limitation by capturing a rapid, sustained uptake seen in infections, driven by ongoing immune and microbial activity, as opposed to the potentially slower uptake in inflammation. This study investigates the potential of dynamic [\n 18<\/jats:sup>\n F]FDG PET\/CT using time-activity curves (TACs) to distinguish infection from inflammation in patients with suspected FRI.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A prospective study was performed in patients referred for [\n 18<\/jats:sup>\n F]FDG PET\/CT examination to detect (the extent of) FRI from December 2021 until November 2024. Final clinical diagnosis of FRI was established according to the criteria defined by the FRI consensus group and used as a reference standard. Dynamic PET imaging was performed using a long axial field-of-view PET\/CT system over a 65-minute period after [\n 18<\/jats:sup>\n F]FDG injection. TACs were analyzed to compare uptake patterns between confirmed infections and inflammation, and diagnostic accuracy was calculated and compared to conventional standard imaging.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirty-one patients with 33 fractures suspected of infection were included. Infection was clinically confirmed in 14 fractures (42%). Diagnosis of FRI based on dynamic imaging using TACs resulted in a high sensitivity of 86%, specificity of 100%, PPV of 100% and NPV of 90%, resulting in a diagnostic accuracy of 94%. In the infection group, Fracture SUV\n peak<\/jats:sub>\n increased progressively over time, while in the inflammation group, uptake appeared to reach a plateau\n (p<\/jats:italic>\n \u2009<\u20090.001). Visual interpretation of the dynamic imaging yielded a diagnostic accuracy of 82%. For standard imaging, quantitative and visual assessments showed diagnostic accuracies of 91% and 88%, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n This proof-of-concept study demonstrates that dynamic [\n 18<\/jats:sup>\n F]FDG PET\/CT using TACs can distinguish infection from inflammation in patients with suspected FRI, with high diagnostic accuracy observed, and suggesting a potential advantage over standard imaging. Larger-scale studies are needed to validate these results and explore the full clinical potential of dynamic imaging in infection management.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s00259-025-07563-x","type":"journal-article","created":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T08:32:31Z","timestamp":1758357151000},"page":"2167-2177","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical evaluation of dynamic [18F]FDG PET imaging to distinguish infection from inflammation in fracture-related infections"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7132-9792","authenticated-orcid":false,"given":"N. 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W.J.M.","family":"Glaudemans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9420-2732","authenticated-orcid":false,"given":"F. F.A.","family":"IJpma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,20]]},"reference":[{"issue":"2","key":"7563_CR1","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1007\/s00259-024-06915-3","volume":"52","author":"G Abikhzer","year":"2024","unstructured":"Abikhzer G, Treglia G, Pelletier-Galarneau M, Buscombe J, Chiti A, Dibble EH, et al. EANM\/SNMMI guideline\/procedure standard for [18F]FDG hybrid PET use in infection and inflammation in adults v2.0. European Journal of Nuclear Medicine and Molecular Imaging. 2024;52(2):510\u201338. https:\/\/doi.org\/10.1007\/s00259-024-06915-3.","journal-title":"European Journal of Nuclear Medicine and Molecular Imaging"},{"issue":"7","key":"7563_CR2","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/j.crad.2015.03.010","volume":"70","author":"S Vaidyanathan","year":"2015","unstructured":"Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU. FDG PET\/CT in infection and inflammation\u2013current and emerging clinical applications. Clin Radiol. 2015;70(7):787.","journal-title":"Clin Radiol"},{"issue":"10","key":"7563_CR3","doi-asserted-by":"publisher","first-page":"1986","DOI":"10.1007\/s00259-010-1587-x","volume":"37","author":"AWJM Glaudemans","year":"2010","unstructured":"Glaudemans AWJM, Signore A. FDG-PET\/CT in infections: the imaging method of choice? Eur J Nucl Med Mol Imaging. 2010;37(10):1986\u201391. https:\/\/doi.org\/10.1007\/s00259-010-1587-x.","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"4","key":"7563_CR4","doi-asserted-by":"publisher","first-page":"647","DOI":"10.2967\/jnumed.112.112524","volume":"54","author":"F Jamar","year":"2013","unstructured":"Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ, et al. EANM\/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med. 2013;54(4):647.","journal-title":"J Nucl Med"},{"issue":"3","key":"7563_CR5","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1016\/j.injury.2016.09.019","volume":"49","author":"WJ Metsemakers","year":"2018","unstructured":"Metsemakers WJ, Kuehl R, Moriarty TF, Richards RG, Verhofstad MHJ, Borens O, et al. Infection after fracture fixation: current surgical and microbiological concepts. Injury. 2018;49(3):511\u201322.","journal-title":"Injury"},{"issue":"8","key":"7563_CR6","doi-asserted-by":"publisher","first-page":"1583","DOI":"10.1007\/s00259-019-04378-5","volume":"46","author":"AWJM Glaudemans","year":"2019","unstructured":"Glaudemans AWJM, Bosch P, Slart RHJA, IJpma FFA, Govaert GAM. Diagnosing fracture-related infections: can we optimize our nuclear imaging techniques? Eur J Nucl Med Mol Imaging. 2019;46(8):1583\u20137. https:\/\/doi.org\/10.1007\/s00259-019-04378-5.","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"7563_CR7","doi-asserted-by":"publisher","unstructured":"Alberts I, Sari H, Mingels C, Afshar-Oromieh A, Pyka T, Shi K et al. Long-axial field-of-view PET\/CT: perspectives and review of a revolutionary development in nuclear medicine based on clinical experience in over 7000 patients. Cancer Imaging 2023 23:1 [Internet]. 2023 Mar 18 [cited 2025 Apr 3];23(1):1\u201315. 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Arch Orthop Trauma Surg. 2021;141(7):1115.","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["European Journal of Nuclear Medicine and Molecular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07563-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00259-025-07563-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00259-025-07563-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T04:43:13Z","timestamp":1769834593000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00259-025-07563-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,20]]},"references-count":14,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["7563"],"URL":"https:\/\/doi.org\/10.1007\/s00259-025-07563-x","relation":{},"ISSN":["1619-7070","1619-7089"],"issn-type":[{"value":"1619-7070","type":"print"},{"value":"1619-7089","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,20]]},"assertion":[{"value":"16 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local Medical Ethical Commission of the University Medical Center Groningen (METC number 2023\/040).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The UMCG has a collaboration with Siemens (Partnership UMCG Siemens Healthineers). The funder had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results. Riemer H. J. A. Slart serves as an editor of the\n European Journal of Nuclear Medicine and Molecular Imaging.\n Other authors have no relevant financial or non-financial interests to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}