Accuracy comparison of various quantitative [99mTc]Tc-DPD SPECT/CT reconstruction techniques in patients with symptomatic hip and knee joint prostheses

Abstract

Background There is a need for better diagnostic tools that identify loose total hip and knee arthroplasties. Here, we present the accuracy of different 99mTc-dicarboxypropandiphosphate ([99mTc]Tc-DPD) SPECT/CT quantification tools for the detection of loose prostheses in patients with painful hip and knee arthroplasties. Methods Quantitative reconstruction of mineral phase SPECT data was performed using Siemens xSPECT-Quant and xSPECT-Bone, with and without metal artefact reduction (iMAR) of CT-data. Quantitative data (SUVmax values) were compared to intraoperative diagnosis or clinical outcome after at least 1 year as standard of comparison. Cut-off values and accuracies were calculated using receiver operator characteristics. Accuracy of uptake quantification was compared to the accuracy of visual SPECT/CT readings, blinded for the quantitative data and clinical outcome. Results In this prospective study, 30 consecutive patients with 33 symptomatic hip and knee prostheses underwent [99mTc]Tc-DPD SPECT/CT. Ten arthroplasties were diagnosed loose and 23 stable. Mean-SUVmax was significantly higher around loose prostheses compared to stable prostheses, regardless of the quantification method (P = 0.0025–0.0001). Quantification with xSPECT-Bone-iMAR showed the highest accuracy (93.9% [95% CI 79.6–100%]) which was significantly higher compared to xSPECT-Quant-iMAR (81.8% [67.5–96.1%], P = 0.04) and xSPECT-Quant without iMAR (77.4% [62.4–92.4%], P = 0.02). Accuracies of clinical reading were non-significantly lower compared to quantitative measures (84.8% [70.6–99.1%] (senior) and 81.5% [67.5–96.1%] (trainee)). Conclusion Quantification with [99mTc]Tc-DPD xSPECT-Bone-iMAR discriminates best between loose and stable prostheses of all evaluated methods. The overall high accuracy of different quantitative measures underlines the potential of [99mTc]Tc-DPD-quantification as a biomarker and demands further prospective evaluation in a larger number of prosthesis.

Review of the role of bone-SPECT/CT in tarsal coalitions

“…Corrections for photon attenuation and scatter, collimator modeling, and reconstruction, have improved reconstruction, thus enabling absolute SPECT quantification [38]. However, the evidence for the added clinical value of quantitative bone-SPECT/CT over visual assessment in both primary diagnosis and in the follow-up of benign diseases is still very limited, and more research is needed to precisely correlate (changes) in measured SUV max to (change in) clinical findings [22,25,28].…”

“…In another scenario, co-existing or newly developed pathologies (at other sites) can be sensitively detected, such as (secondary) osteoarthritis [25,28].…”

“…In another scenario, co-existing or newly developed pathologies (at other sites) can be sensitively detected, such as (secondary) osteoarthritis [25,28]. Figure 16 (coronal reconstructions shown), comparing preoperative and postoperative bone-SPECT/CT scans of a male patient of 41 years at first imaging, exemplifies this development with uptake in the TCC actually having decreased considerably (red circle) 2 years after arthrodesis, but a new focus of increased bone turnover at the site of arthrodesis laterally from the TCC has emerged (blue circle), developing new pain complaints.…”

“…Bone-SPECT on the other hand is much less hampered and will usually be able to precisely pinpoint the location of the possible pain generator. The quality of CT can be impaired by hardware-induced artifacts, which might be (partly) overcome using metal artifact reduction (Please see Table 3) [28]. Bone-SPECT/CT performance before and after arthrodesis is illustrated by a 35-year-old patient with non-osseous TCC (middle facet).…”

A Prospective Comparative Study of Using Ultrasonography, 4D-CT and Parathyroid Dual-Phase Scintigraphy with SPECT in Patients with Primary Hyperparathyroidism

“…Standardized quantitative SPECT imaging with xSPECT Bone (TM) using CT-derived anatomical delineation for tissue boundary differentiation showed promise in assessment of symptomatic hip and knee joint prostheses, where quantification with 99mTcdicarboxypropandiphosphate (DPD) allows for best discrimination between loose and stable prostheses among all of the evaluated methods [3,4]. In another use case in bone imaging for prostate and breast cancer, xSPECT Bone yielded an SUV-threshold for sensitivity allowing to distinguish benign and malignant lesions [3,4].…”