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Open Access
CC BY 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/a-2796-6952
Original Cardiovascular

Enhanced uptake of FDG in PET/CT after the use of bone wax during sternotomy.

Authors

  • Michael Jüptner

    1   Department of Nuclear Medicine, Molecular Diagnostic Imaging and Therapy, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)

  • Bernd Panholzer 

    2   Cardiac Surgery, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)

  • Anette Friedrichs

    3   Department of Internal Medicine I, Infectious Diseases, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)

  • Gregor Warnecke

    2   Cardiac Surgery, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)

  • Jochen T. Cremer

    4   Department for Cardiac Surgery, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)

  • Alexander Thiem

    2   Cardiac Surgery, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)

  • Ulf Luetzen

    1   Department of Nuclear Medicine, Molecular Diagnostic Imaging and Therapy, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)

  • Jan Schoettler

    2   Cardiac Surgery, University Hospital Schleswig-Holstein - Campus Kiel, Kiel, Germany (Ringgold ID: RIN54186)
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Objective: Physiologic healing processes and foreign body reactions can mimic infective conditions in 18F-FDG-PET/CT for the detection of deep sternal wound infections. To date, nothing is known about the metabolic presentation of surgically applied bone wax to the sternum for hemostasis during sternotomy in 18F-FDG-PET/CT imaging. Therefore, this study aims to assess the sternal FDG uptake after the application of bone wax during sternotomy. Methods: 25 patients with a history of cardiac surgery were examined by 18F-FDG-PET/CT with dual time point imaging. The sternal FDG uptake was assessed visually (as positive or negative) and metrically using the maximum Standardized Uptake Values (SUVmax) calculated automatically. The SUVmax was compared between the patients with and without the use of bone wax and among patients with and without positive sternal findings in the visual analysis. A correlation analysis was performed between the time since surgery and the sternal SUVmax. Results: 8 patients (32%) had received bone wax. In those patients, the mean sternal SUVmax was higher compared to the group without bone wax, both in the early (4.74±1.28 vs. 3.70±1.44;p=0.0969) and in the late images (6.62±2.67 vs. 4.36±1.44;p=0.0289). Moreover, the use of bone wax was strongly associated with positive sternal findings in the visual analysis (OR=10;95%CI=0.995-100.462;p=0.0421). The correlation analysis revealed a decreasing trend without significance (ρ=-0.139;p=0.505). Conclusions: The use of bone wax during sternotomy could be associated with increased sternal FDG uptake on 18F-FDG-PET/CT, even several years after surgery. This finding should be considered in the evaluation of potential deep sternal wound infection.



Publication History

Received: 20 August 2025

Accepted after revision: 23 January 2026

Accepted Manuscript online:
28 January 2026

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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