Diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic joint prostheses loosening

Abstract

Purpose To evaluate the diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic prosthesis loosening following hip and knee arthroplasty. Methods A retrospective review of 63 SPECT/CT arthrogram studies (36 knees and 27 hips) between February 1, 2013, and July 1, 2018, was conducted. All patients underwent clinical and radiologic evaluation as part of their assessment for persistent pain following hip and knee arthroplasty. The detection of tracer activity along the bone-prosthetic interface on SPECT/CT suggests aseptic loosening. Operative assessment as well as clinical/radiologic follow-up at a minimum of 1 year was used as the reference standard. Results The sensitivity and specificity of SPECT/CT for detection of aseptic loosening was 6/7 (86%) and 55/56 (98%), respectively. This gives a positive predictive value (PPV) of 6/7 (86%), a negative predictive value (NPV) of 55/56 (98%), and a diagnostic accuracy of 61/63 (97%). Conclusion SPECT/CT arthrography has a high diagnostic accuracy (97%) in the evaluation of loosening of both hip and knee arthroplasties in patients with persistent post-procedural pain.

The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis—a diagnostic test accuracy review

“…Better diagnostic performance for tibial component. A negative result excluded with high accuracy a pathological condition Bao et al [ 42 ] 36 Diagnostic retrospective III TKA 99m Tc Sulf Colloid i.a Intraoperative, follow-up 0.50 0.97 SPECT/CT arthrography showed high accuracy for detecting loosening in painful knee arthroplasty and excluding pathological condition. They showed that a detection of tracer activity along the bone interface was related to aseptic loosening Chew et al [ 43 ] 44 Diagnostic retrospective III TKA 99m Tc Ca Phyt i.a Intraoperative 0.75–0.86 0.63–0.86 They reported different diagnostic performance values according to the anatomical place of the knee replacement.…”

“…Bo Bao [ 42 ] reported on a retrospective cohort of 36 patients who underwent clinical and radiological evaluation for persistent pain following knee arthroplasty. With a medium risk of bias under the QUADAS-2 tool (explained by the flow and timing domain, as intraoperative findings and/or clinical or radiological evaluations were used as the reference standard), the authors reported a SEN of 0.50 [95% CI: 0.01–0.99] and a SPE of 0.97 [95% CI: 0.85–1.00] for the SPECT/CT arthrogram in detecting aseptic loosening.…”

“…The best diagnostic performance with the highest sensitivity and negative predictive values was found for loosening of the prosthetic components when the bone radiotracer 99 mTc sulphur colloid was used intraarticularly (SPECT/CT arthrography) [ 39 , 42 ].…”

“…Three authors [ 41 , 43 , 46 ] reported different sensitivities and specificities for each compartment, highlighting that although the values for detecting patellofemoral osteoarthritis in unresurfaced patellae were high (95% sensitivity), the performance was better in detecting loosening of the tibial and femoral components (98%, 0.90–1.00 and 0.73%, 0.39–0.94, respectively). The highest diagnostic accuracy for SPECT/CT in detecting loosening was reported by Abele et al and Bao et al [ 39 , 42 ], who used intraarticular administration of the radiotracer 99m Tc sulphur colloid with a sensitivity and negative predictive value of 100%, which was superior to other imaging methods. SPECT/CT was also able to identify other sources of pain, such as patellofemoral hyper pressure, instability and malalignment of the components, with findings confirmed by intraoperative or clinical follow-up [ 21 , 47 ].…”

Passive Biotelemetric Detection of Tibial Debonding in Wireless Battery-Free Smart Knee Implants

“…Indeed, aseptic loosening is often only confirmed intra- or postoperatively, with the preoperative assessment frequently being a misdiagnosis of a low-grade infection [ 27 ]. Several radionuclide imaging techniques—scintigraphic [ 28 , 29 ] and tomographic [ 30 , 31 , 32 ]—have been implemented to provide more conclusive diagnoses of aseptic loosening [ 24 ]; radionuclide imaging has also been used to detect periprosthetic joint infection with reasonable success, but these advanced imaging techniques are time-consuming and only available at specialist centres.…”