FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis

Abstract

Purpose The aim of this study was to systematically review and metaanalyze published data on the diagnostic performance of 18 F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) in detecting prosthetic hip or knee joint infection. Methods A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Two reviewers independently assessed the methodological quality of each study. A metaanalysis of the reported sensitivity and specificity of each study was performed. Subgroup analyses were performed if results of individual studies were heterogeneous. Results The inclusion criteria were met by 11 studies; there was a total sample size of 635 prostheses. Overall, the studies had good methodological quality. Pooled sensitivity and specificity of FDG-PET for the detection of prosthetic hip or knee joint infection were 82.1% (95%CI=68.0-90.8%) and 86.6% (95%CI=79.7-91.4%), respectively. Heterogeneity among the results of individual studies was present (I 2 =68.8%). Diagnostic performance was influenced by type of joint prostheses (hip prostheses vs. knee prostheses) and type of reconstruction method used (filtered back vs. iterative) (p=0.0164 and p=0.0235, respectively). Conclusion In this metaanalysis, overall diagnostic performance of FDG-PET was moderate to high. Caution is warranted, however, because results of individual studies were heterogeneous and could not be fully explored. Future studies should further explore potential causes of heterogeneity and validate the use of FDG-PET for diagnosing prosthetic joint infection.

FDG-PET imaging to detect and characterize infectious disorders; an unavoidable path for the foreseeable future

“…Although most reports described in the literature deal with detection of infection in the lungs [14,15] and the skeletal system [16][17][18], FDG-PET has been shown to be just as successful in other locations throughout the body [14]. The data published in the literature are very convincing and clearly demonstrate the critical role that this tracer can play in effective management of many common infectious disorders.…”

Prosthetic Joint Infection

“…A meta-analysis of 11 studies involving 635 prosthetic hip and knee arthroplasties found that FDG-PET had pooled sensitivity and specificity values of 82.1 and 86.6%, respectively, for the diagnosis of PJI (272). A limitation of this technique is its high cost.…”

Patient and Personnel Radiation Exposure in Sentinel Lymph Node Practice

“…Semi-kantitatif değerlendirmede, onkolojideki kadar olmasa da enflamasyon ve enfeksiyonda standardize tutulum değeri (SUV) dikkate alınmış, enfeksiyon ile enflamasyon ayırıcı tanısında faydalı bulunmamıştır (9,10). Yapılan bir metaanalizde FDG'nin ortopedik protez enfeksiyonları tanısında hassasiyet ve özgüllüğü %82 ve %87 olarak, işaretli lökosit/ kemik iliği çalışmasına göre düşük bulunmuştur (55). Ayrıca kalça-diz protez cerrahisi geçirenlerde, işaretli lökosit/kemik iliği sintigrafisinin birlikte kullanılarak, enfeksiyon tanısında karşılaştırıldığı bir çalışmada FDG PET görüntülemenin doğruluğu daha az bulunmuştur (32).…”