Diagnostic accuracy of combined 99mTc-sulesomab and 99mTc-nanocolloid bone marrow imaging in detecting prosthetic joint infection

Sousa, Ricardo; Massada, Marta; Pereira, Alexandre da Costa; Fontes, Flávia; Amorim, Inês; Oliveira, Antônio Ribeiro de

doi:10.1097/mnm.0b013e3283496695

Cited by 45 publications

(34 citation statements)

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“…Moreover, antibodies, having a small molecular weight (antibody fragments), may accumulate in sites of sterile inflammation due to extravascular leaking with oedema, thus giving false positive results. Nevertheless, results of recently published studies in patients with PJI show the high diagnostic accuracy of radiolabelled antibodies (besilesomab and sulesomab), similarly to radiolabelled WBC (Iyengar et al, 2006;Blazeski et al, 2010;Richter et al, 2011;Sousa et al, 2011). Another study that compared an intact MoAb (besilesomab) with a fragmented MoAb AWJM Glaudemans et al…”

Section: Interpretation Criteriamentioning

confidence: 98%

Leukocyte and bacteria imaging in prosthetic joint infection

Glaudemans

Galli

Pacilio

et al. 2013

eCM

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There has been a significant increase in the number of joint prosthesis replacements worldwide. Although relatively uncommon, complications can occur with the most serious being an infection. Various radiological and nuclear imaging techniques are available to diagnose prosthetic joint infections (PJI). In this review article, we describe the pathophysiology of PJI, the principles of nuclear medicine imaging and the differences between Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET). The value of nuclear medicine techniques for clinical practice is also discussed.Then we provide an overview of the most often used radionuclide imaging techniques that may be helpful in diagnosing prosthetic joint infection: the 67 Ga-citrate, labelled white blood cells in vitro and in vivo (monoclonal antibodies directed against specific targets on the leukocytes), and 18 F-fluorodeoxyglucose ( 18 F-FDG). We describe their working methods, the pitfalls, and the interpretation criteria. Furthermore, we review recent advances in imaging bacteria, a molecular imaging method that holds promises for the detection of occult infections. We conclude proposing two diagnostic flow-charts, based on data in the literature, that could help the clinicians to choose the best nuclear imaging method when they have a patient with suspicion of or with proven PJI.

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Section: Interpretation Criteriamentioning

confidence: 98%

Leukocyte and bacteria imaging in prosthetic joint infection

Glaudemans

Galli

Pacilio

et al. 2013

eCM

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“…Sequential bone/gallium scintigraphy In an effort to enhance the radionuclide diagnosis of PJI, 67 Ga-citrate scintigraphy (GS) often is improved in addition to BS and the two studies are interpreted together using standardized • Antigranulocyte antibodies or fragments ( 99m Tc)…”

Section: Imaging Techniques and Featuresmentioning

confidence: 99%

“…3a criteria [22][23][24]. Since both gallium and diphosphonates are bone-seeking radiopharmaceuticals, 67 Ga-citrate is not accurate enough to image PJI. Similar to diphosphonates, gallium also accumulates not only in infection, but also in the postoperative patient, in heterotopic or periosteal new bone formation, aseptic loosening, fractures and even granulomatous reaction to prosthetic cement [24,25].…”

Section: Imaging Techniques and Featuresmentioning

confidence: 99%

“…Images are therefore interpreted by established criteria comparing congruity of the spatial distribution and intensity of the two scans. Although sequential BS/GS, with an accuracy ranging from 65 to 80%, provides somewhat better results than BS alone, it seems to be of limited value for diagnosing PJI, also in combination with a number of drawbacks inherent to 67 Ga-citrate [14,24,26,27] (Fig. 4).…”

Section: Imaging Techniques and Featuresmentioning

confidence: 99%

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Prosthetic joint infections: radionuclide state-of-the-art imaging

Gemmel¹,

Wyngaert²,

Love

et al. 2012

Eur J Nucl Med Mol Imaging

165

151

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Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort has been devoted to developing alternative radiotracers, such as radiolabelled HIGs, liposomes, antigranulocyte antibodies and fragments, as well as more investigational tracers such as radiolabelled antibiotics, antimicrobial peptides, bacteriophages and thymidine kinase. On the other hand, positron emission tomography (PET) is still growing in the field of PJI imaging with radiotracers such as (18)F-fluorodeoxyglucose (FDG), (18)F-FDG white blood cells and (18)F-fluoride. But unfortunately this superb tomographic technique will only receive full acceptance when specific PET uptake patterns can be successfully developed. The emergence of hybrid modality imaging using integrated single photon emission computed tomography (SPECT) and PET with computed tomography (SPECT/CT and PET/CT) may also have a contributing role for more accurate assessment of joint replacement complications, especially combined with new radiotracers such as (68)Ga and (64)Cu. Finally, in searching for infection-specific tracers, currently there is no such diagnostic agent available.

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“…Antikorlar, antikor fragmanları (daha küçük molekül ağırlıklı) steril enflamasyon alanında akümüle olabilir, ödem ve ekstravasküler sızıntı nedeni ile yalancı pozitif sonuç verebilirler. Yine de, ortopedik protez enfeksiyonu hastalarında radyoaktif işaretli antikorların tanısal doğruluğu, radyoaktif işaretli lökositlere benzer olarak, yüksek bulunmuştur (17,51).…”

Section: İnvivoi̇şaretlilökosit İşaretlimonoklonalantikorlarunclassified