Anna Vincek 1, Mathieu Spriet 1, Denis J Marcellin-Little 1, Amy S Kapatkin 1, Barbro Filliquist 1, Po-Yen Chou 1
Background
Assessing bone healing and implant stability post-orthopedic surgery in dogs is challenging with conventional imaging techniques. This study investigates the feasibility and diagnostic utility of using ^18F-sodium fluoride (NaF) PET/CT for evaluating bone activity around surgical implants in canine patients, particularly to detect active bone remodeling and complications such as infection or nonunion.
Methods
Ten dogs with orthopedic implants (plates, screws, or prosthetics) were prospectively evaluated using ^18F-NaF PET/CT. Dogs underwent a whole-body PET scan approximately 60 minutes after intravenous administration of ^18F-NaF, combined with CT imaging for anatomical localization. Regions of interest were drawn around implants, contralateral sites, and background tissues to quantify standardized uptake values (SUVs). Imaging findings were compared with clinical and surgical outcomes.
Results
^18F-NaF PET/CT successfully identified increased tracer uptake in regions with known or suspected bone remodeling, infection, or implant instability. In dogs with healing complications, SUVmax values were significantly higher around the affected implants compared to contralateral sites. In contrast, stable and clinically unremarkable implants showed low and uniform uptake. PET/CT enabled identification of subclinical pathology and was instrumental in decision-making for revision surgeries or continued medical management.
Limitations
The study included a small, heterogeneous sample size, limiting statistical power and generalizability. The timing of imaging varied, and long-term follow-up was not uniformly available. Potential interference from metallic artifacts in CT and variable soft tissue activity could affect interpretation.
Conclusions
^18F-NaF PET/CT is a promising tool for evaluating orthopedic implants in dogs, offering functional insight into bone activity that complements structural imaging. It enables early detection of complications such as infection or impaired healing and may guide clinical management. Larger studies are needed to validate thresholds and establish routine clinical protoc
Dorsal 18F-NaF PET (A), CT (B), and fused 18F-NaF PET/CT (C) images as well as sagittal CT (D) and fused 18F-NaF PET/CT (E) images of the pelvis of a 4-year-old German Shorthaired Pointer (Patient 3), 12 months post right total hip replacement (THR) surgery. There is severe implant-associated IRU (SUVmax 24) with septic implant inflammation, septic arthritis, and osteomyelitis (arrow).
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