Sequential Indium-Labeled Leukocyte and Bone Scans to Diagnose Prosthetic Joint Infection

Teller, Roger; Christie, Michael J.; Martin, William R.; Nance, E. Paul; Haas, David

doi:10.1097/00003086-200004000-00029

Cited by 82 publications

(24 citation statements)

References 11 publications

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“…These results are comparable to those of other studies (Table 1). An inappropriate incubation time may be the reason for the poor sensitivity of tests with preoperative joint aspiration fluids reported in other studies, namely 12% reported by Johnson et al [26] and 28% by Teller et al [50]. However, many publications do not comment on the duration of the incubation [2,13,25,28,29,40], which suggests that in such cases the samples would have been incubated for 3 days, which is the standard time for bacterial incubations.…”

Section: Discussionmentioning

confidence: 99%

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

Fink

Gebhard

Fuerst³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

Fink

Gebhard

Fuerst³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…However, in the largest retrospective study on suspected hip prostheses comprising 116 patients, Teller et al (2000) found a sensitivity of 64% and a specificity of 78% and concluded that routine use of white blood cell scintigraphy in combination with bone scintigraphy could not be used to differentiate between loosening and infection. Another study combined 99m Tc marrow scintigraphy with 111 In leukocyte scintigraphy to detect infected total hip and knee arthroplasties and found a sensitivity of 46% and specificity of 100% (Joseph et al 2001).…”

Section: Discussionmentioning

confidence: 99%

White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

et al. 2007

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“…In the largest retrospective study on suspected hip prostheses comprising 116 patients, Teller et al found, besides a lower sensitivity of 64% and a moderate high specificity of 78%, that a positive 111 In LS only increased the likelihood of infection from 14 to 30%, although negative results decreased the likelihood to 7% [45]. The distribution of activity on the bone and gallium images is spatially incongruent and the combined study is (true) positive for infection.…”

Section: Ant Antmentioning

confidence: 99%

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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Sequential Indium-Labeled Leukocyte and Bone Scans to Diagnose Prosthetic Joint Infection

Cited by 82 publications

References 11 publications

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

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

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