The clinical contribution of SPECT/CT with 99mTc-HMPAO-labeled leukocyte scintigraphy in hip and knee prosthetic infections

Şengöz, Tarık; Yaylalı, Olga; Yüksel, Doğangün; Demirkan, Fahir; Uluyol, Özlem

doi:10.1016/j.remnie.2019.02.003

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…This discrepancy is explained by the chosen domain of our patients. Most of the published studies included patients with a high probability of infection (El Espera et al, 2004;Segura et al, 2004;Pelosi et al, 2004;Love et al, 2004;Pill et al, 2006;Simonsen et al, 2007;Rubello et al, 2008a, b;Love et al, 2009;Glaudemans et al, 2013;Kwee et al, 2013;Kim et al, 2014;Trevail et al, 2016;Auletta et al, 2019;Sengoz et al, 2019;Blanc et al, 2019;Teiler et al, 2020). These studies entail small cohorts of patients (ranging from 19 to 89 patients) and depict a high prevalence of PJI in the studied cohort (ranging from 25 % to 66 %).…”

Section: Discussionmentioning

confidence: 99%

Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience

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Gelderman

Wouthuyzen-Bakker

et al. 2022

J. Bone Joint Infect.

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Abstract. Background: A low-grade periprosthetic joint infection (PJI) may present without specific symptoms, and its diagnosis remains a challenge. Three-phase bone scintigraphy (TPBS) and white blood cell (WBC) scintigraphy are incorporated into recently introduced diagnostic criteria for PJI, but their exact value in diagnosing low-grade PJI in patients with nonspecific symptoms remains unclear. Methods: In this retrospective study, we evaluated patients with a prosthetic joint of the hip or knee who underwent TPBS and/or WBC scintigraphy between 2009 and 2016 because of nonspecific symptoms. We reviewed and calculated diagnostic accuracy of the TPBS and/or WBC scintigraphy to diagnose or exclude PJI. PJI was defined based on multiple cultures obtained during revision surgery. In patients who did not undergo revision surgery, PJI was ruled out by clinical follow-up of at least 2 years absent of clinical signs of infection based on MSIS 2011 criteria. Results: A total of 373 patients were evaluated, including 340 TPBSs and 142 WBC scintigraphies. Thirteen patients (3.5 %) were diagnosed with a PJI. TPBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were 71 %, 65 %, 8 % and 98 %, respectively. Thirty-five percent of TPBS showed increased uptake. Stratification for time intervals between the index arthroplasty and the onset of symptoms did not alter its diagnostic accuracy. WBC scintigraphy sensitivity, specificity, PPV and NPV were 30 %, 90 %, 25 % and 94 %, respectively. Conclusion: Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection.

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Section: Discussionmentioning

confidence: 99%

Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience

Ottink

Gelderman

Wouthuyzen-Bakker

et al. 2022

J. Bone Joint Infect.

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Management of periprosthetic knee joint infections: focus on the role of Nuclear Medicine (v2)

et al. 2022

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Background When faced with a painful knee replacement, ruling out infection is mandatory to set the correct therapeutic approach. However, it is not always easy, especially in subclinical/chronic infections. A multidisciplinary approach is necessary to assess in the most correct way each case of suspected periprosthetic knee joint infection. This review explores the role of nuclear medicine investigations in the management of periprosthetic knee infections and their proper use within a multidisciplinary pathway. Methods A PubMed search was conducted selecting studies from the past 10 years. Results Triphasic bone scintigraphy has high sensitivity (93%) but poor specificity (56%) for periprosthetic joint infections of the knee, with a high negative predictive value (NPV), ranging from 96% to 100%. Consequently, a negative bone scan is useful in ruling out infection. In contrast, radiolabeled leukocyte scintigraphy is characterized by a sensitivity of 85.7-93%, specificity of 93.6-100%, diagnostic accuracy of 92.6-98%, NPV of 93-97.8%, and positive predictive value (PPV) of 66.7-100%. By adding a tomographic acquisition with hybrid single-photon emission computed tomography combined with computed tomography technique (SPECT/CT), the diagnostic accuracy increases. Because 18F-fluorodeoxyglucose (FDG) accumulates at both sites of inflammation and infection, FDG positron emission tomography (PET/CT) shows low specificity. Conclusions A common decision-making process in the diagnosis of periprosthetic joint infection is not yet validated and multidisciplinary integration is mandatory. In this context, nuclear medicine can contribute decisively.

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The clinical contribution of SPECT/CT with 99mTc-HMPAO-labeled leukocyte scintigraphy in hip and knee prosthetic infections

Cited by 2 publications

References 22 publications

Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience

Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience

Management of periprosthetic knee joint infections: focus on the role of Nuclear Medicine (v2)

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