Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria

Abstract

Aims Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. Patients and Methods A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. Results The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. Conclusion FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910–914.

Application of [68Ga]Ga-citrate PET/CT for Differentiating Prosthetic Joint Infection from Aseptic Loosening After Joint Replacement Surgery

“…An accurate and timely diagnosis is crucial for implementing the correct treatment strategy. However, AL and PJI can result in similar symptoms such as pain, swelling, and di culty walking [6,19,25]; in addition, chronic and low-grade infections are more common than acute PJI in the clinical environment and such patients lack the typical clinical symptoms and signs of an infection [4,6,9]. This makes differentiating between AL and PJI challenging.…”

“…This makes differentiating between AL and PJI challenging. Various clinical assessment methods are currently used to con rm the diagnosis, including laboratory examination, X-ray examination, CT imaging, MRI, bone scan, [ 67 Ga]Ga-citrate imaging, radioactivelabelled leukocyte scintigraphy, [ 18 F]FDG PET/CT imaging, joint aspiration, and microbial culture [3,4,7,25]. However, routine laboratory tests and imaging examinations often provide non-speci c results, and joint aspiration may not be successful [1,3,5,9,26].…”

The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements

“…In an investigation of 21 patients with suspected PJI of the knee, [ 18 F]-FDG-PET was 100% sensitive, but only 73% specific for infection [63]. In a recent investigation in 130 patients with suspected PJI of the hip, with final diagnosis based on the criteria recommended by the MSIS, [ 18 F]-FDG-PET/CT yielded a sensitivity and specificity of 95% and 39%, respectively, for infection [64]. Based on the available literature, it seems reasonable to conclude that a negative result effectively excludes PJI.…”

Efficacy of 16S rRNA variable regions high-resolution melt analysis for bacterial pathogens identification in periprosthetic joint infections

“…One of the most serious and devastating complications after joint arthroplasty is PJI [5,6]. Also, higher revision arthroplasty rates could be due to PJI [7].…”