Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis

Abstract

Background The diagnosis of infected hip prosthesis is frequently not straightforward yet very important as it changes treatment. Purpose To retrospectively investigate the added value of 18F-FDG PET/CT to conventional tests including radiography, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) testing, and joint aspiration, in diagnosing infected hip prosthesis. Material and Methods Seventy-eight hip prostheses of 78 patients (55% men; mean age = 66.5 years; age range = 30-85 years) with non-specific clinical presentation, i.e. no abscess or sinus tract communicating with the joint space at clinical examination, were analyzed. Cultures of intra-articular fluid and peri-implant tissues after revision surgery or clinical follow-up ≥6 months served as gold standard. Areas under the receiver operating characteristic curves (AUCs) of radiography, ESR/CRP testing, aspiration culture, and white blood cell (WBC) count without and with the addition of 18F-FDG PET/CT were compared. Results The addition of 18F-FDG PET/CT increased AUCs: for radiography with 0.212, P = 0.001; for ESR/CRP testing with 0.076, P = 0.072; for aspiration culture with 0.126, P = 0.032; and for aspiration WBC count with 0.191, P = 0.035. Conclusion This study shows that 18F-FDG PET/CT adds to individual conventional tests in diagnosing infected hip prosthesis. It may improve the preoperative planning and should therefore be considered in the diagnostic work-up. Future studies should define the exact place of 18F-FDG PET/CT in the diagnostic work-up of periprosthetic joint infection.

The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica

“…The development of nuclear medicine continued with the introduction of positron emission tomography (PET)/CT, which for musculoskeletal imaging has its primary focus in oncologic imaging and metastasis screening (79,80), also for skeletal muscle metastasis imaging (81). PET/CT also has an important role in imaging of infection, both for spinal infection (82) and in imaging infected prostheses (83).…”

“…Radiologic changes from diseases that are today rare in high-income countries were reported early on, such as tetanus in 1938 (147), syphilis in 1945 (148), leprosy in 1950-1952 (149)(150)(151), and poliomyelitis in 1957 (152). The publications in later years have mostly focused on the ability of newer modalities to diagnose and follow up an infection before and after treatment (83,130,(153)(154)(155), especially after spinal surgery (156,157), with some reports also on parasitic diseases (158)(159)(160)(161).…”

18F-FDG PET for Diagnosing Infections in Prosthetic Joints

“…21 In addition, 18 F-FDG PET has shown useful in patients with nonspecific clinical presentation (ie, without apparent clinical signs and symptoms, such as absence of a sinus tract). 32,33 Furthermore, it has additional value to conventional tests (including radiography, erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP] testing, and joint aspiration culture and white blood cell count) in diagnosing PJI (ie, it increases accuracy). 33…”

“…32,33 Furthermore, it has additional value to conventional tests (including radiography, erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP] testing, and joint aspiration culture and white blood cell count) in diagnosing PJI (ie, it increases accuracy). 33…”

Future Perspective of the Application of Positron Emission Tomography-Computed Tomography-MR Imaging in Musculoskeletal Disorders

“…21 In addition, 18 F-FDG PET has shown useful in patients with nonspecific clinical presentation (ie, without apparent clinical signs and symptoms, such as absence of a sinus tract). 32,33 Furthermore, it has additional value to conventional tests (including radiography, erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP] testing, and joint aspiration culture and white blood cell count) in diagnosing PJI (ie, it increases accuracy). 33…”