Imaging of low-grade bone infection with a technetium-99m labelled monoclonal anti-NCA-90 Fab' fragment in patients with previous joint surgery

Ivanćević, V.; Perka, C.; Hasart, O.; Sandrock, D.; Munz, D.

doi:10.1007/s00259-002-0857-7

Cited by 23 publications

(13 citation statements)

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“…Of the 23 studies included for meta-analysis, six used bone scintigraphy [12, 20, 27, 34, 40, 50], four used bone leukocyte scintigraphy [20, 34, 41, 50], six used leukocyte scintigraphy [18, 28, 34, 37, 38, 50], seven used leukocyte bone marrow scintigraphy [2, 7, 9, 16, 17, 21, 34], five used antigranulocyte scintigraphy [14, 15, 40, 44, 52], and five used fluorodeoxyglucose (FDG)-PET [2, 21, 23, 50, 56]. Altogether, a total of 1027 diagnostic images, 404 (39%) with and 623 (61%) without periprosthetic knee infection, were evaluated in 1502 patients with 763 knee prostheses, of which 288 (38%) were infected (Table 1).…”

Section: Methodsmentioning

confidence: 99%

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Verberne

Sonnega

Temmerman

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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BackgroundIn the assessment of possible periprosthetic knee infection, various imaging modalities are used without consensus regarding the most accurate technique.Questions/PurposesTo perform a meta-analysis to compare the accuracy of various applied imaging modalities in the assessment of periprosthetic knee infection.MethodsA systematic review and meta-analysis was conducted with a comprehensive search of MEDLINE and Embase® in accordance with the PRISMA and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) recommendations to identify clinical studies in which periprosthetic knee infection was investigated with different imaging modalities. The sensitivity and specificity of each imaging technique were determined and compared with the results of microbiologic and histologic analyses, intraoperative findings, and clinical followup of more than 6 months. A total of 23 studies, published between 1990 and 2015, were included for meta-analysis, representing 1027 diagnostic images of symptomatic knee prostheses. Quality of the included studies showed low concerns regarding external validity, whereas internal validity indicated more concerns regarding the risk of bias. The most important concerns were found in the lack of uniform criteria for the diagnosis of a periprosthetic infection and the flow and timing of the included studies. Differences among techniques were tested at a probability less than 0.05 level. Where there was slight overlap of confidence intervals for two means, it is possible for the point estimates to be statistically different from one another at a probability less than 0.05. The z-test was used to statistically analyze differences in these situations.ResultsBone scintigraphy was less specific than all other modalities tested (56%; 95% CI, 0.47–0.64; p < 0.001), and leukocyte scintigraphy (77%; 95% CI, 0.69–0.85) was less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88–0.98; p < 0.001) or combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86–0.97; p < 0.001). Fluorodeoxyglucose positron emission tomography (FDG-PET) (84%; 95% CI, 0.76–0.90) was more specific than bone scintigraphy (56%; 95% CI, 0.47–0.64; p < 0.001), and less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88–0.98; p = 0.02) and combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86–0.97; p < 0.001). Leukocyte scintigraphy (88%; 95% CI, 0.81–0.93; p = 0.01) and antigranulocyte scintigraphy (90%; 95% CI, 0.78–0.96; p = 0.02) were more sensitive than FGD-PET (70%; 95% CI, 0.56–0.81). However, because of broad overlapping of confidence intervals, no differences in sensitivity were observed among the other modalities, including combined bone scintigraphy (93%; 95% CI, 0.85–0.98) or combined leukocyte and bone marrow scintigraphy (80%; 95% CI, 0.66–0.91; p > 0.05 for all paired comparisons).ConclusionsBased on current evidence, antigranulocyte scintigraphy and combined leukocyte and bone marrow scintigraphy appear to be highly specific imaging modalities in confirming peripr...

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Section: Methodsmentioning

confidence: 99%

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Verberne

Sonnega

Temmerman

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…The condition of the implant was examined for signs of loosening and/or periprosthetic osteolysis, and graded as stable or unstable [22,25]. In case of inconclusive clinical presentation and normal Wndings in the conventional X-ray, a nuclear scintigraphy was performed [9].…”

Section: Imaging Diagnosticsmentioning

confidence: 99%

“…However, in six of these seven patients, diagnosis was signiWcantly delayed, with a median duration of symptoms of 10 months (IQR 4. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. In only one of these seven patients (case 6), diagnosis was also established without any delay.…”

Section: Clinical Presentationmentioning

confidence: 99%

Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge

Zappe

Graf

Ochsner

et al. 2007

Arch Orthop Trauma Surg

101

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Our data suggest that Propionibacterium associated prosthetic joint infections occur at a relative frequency that is comparable to many other pathogens. Clinical signs are generally subtle, but the spectrum includes also significant soft-tissue damages. In this study, a median of 9.5 biopsies per case, an incubation time of 14 days, and the aid of histopathological examinations proved to be helpful in establishing the diagnosis.

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“…, 1996; Sammak et al. , 1999; Ivancevic et al. , 2002) with various radio pharmaceuticals and imaging techniques have found sensitivities, specificities, and accuracies in detecting osteomyelitis and soft‐tissue infections in the range of 86–100, 58–100 and 48–95%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…With the simultaneous bone-granulocyte scintigraphy we found a high sensitivity, and an acceptable specificity and accuracy. Using per-operative bacterial culture from bone as the gold standard the combined scintigraphy had a higher accuracy than bone and granulocyte scintigraphy read separately, X-ray, Recent publications (Datz & Thorne, 1986;Schauwecker et al, 1988;Schauwecker, 1992;Sciuk et al, 1992;Kolindou et al, 1996; Krznaric et al, 1996;Sammak et al, 1999;Ivancevic et al, 2002) with various radio pharmaceuticals and imaging techniques have found sensitivities, specificities, and accuracies in detecting osteomyelitis and soft-tissue infections in the range of 86-100, 58-100 and 48-95%, respectively. However, in truly complicated osteomyelitis like these of the present study specificity may be even lower (Schauwecker, 1992).…”

Section: Discussionmentioning

confidence: 99%

Bone infection in patients suspected of complicating osteomyelitis: the diagnostic value of dual isotope bone‐granulocyte scintigraphy

Buhl¹,

Stentzer

Hede

et al. 2005

Clin Physio Funct Imaging

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Imaging of low-grade bone infection with a technetium-99m labelled monoclonal anti-NCA-90 Fab' fragment in patients with previous joint surgery

Cited by 23 publications

References 0 publications

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge

Bone infection in patients suspected of complicating osteomyelitis: the diagnostic value of dual isotope bone‐granulocyte scintigraphy

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