The Role of Nuclear Medicine Imaging with 18F-FDG PET/CT, Combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT in the Evaluation of Patients with Chronic Problems after TKA or THA in a Prospective Study

Abstract

Background: The aim of this prospective study was to assess the diagnostic value of nuclear imaging with 18F-FDG PET/CT (FDG PET/CT), combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT (dual-isotope WBC/bone marrow scan) for patients with chronic problems related to knee or hip prostheses (TKA or THA) scheduled by a structured multidisciplinary algorithm. Materials and Methods: Fifty-five patients underwent imaging with 99mTc–HDP SPECT/CT (bone scan), dual-isotope WBC/bone marrow scan, and FDG PET/CT. The final diagnosis of prosthetic joint infection (PJI) and/or loosening was based on the intraoperative findings and microbiological culture results and the clinical follow-up. Results: The diagnostic performance of dual-isotope WBC/bone marrow SPECT/CT for PJI showed a sensitivity of 100% (CI 0.74–1.00), a specificity of 97% (CI 0.82–1.00), and an accuracy of 98% (CI 0.88–1.00); for PET/CT, the sensitivity, specificity, and accuracy were 100% (CI 0.74–1.00), 71% (CI 0.56–0.90), and 79% (CI 0.68–0.93), respectively. Conclusions: In a standardized prospectively scheduled patient group, the results showed highly specific performance of combined dual-isotope WBC/bone marrow SPECT/CT in confirming chronic PJI. FDG PET/CT has an appropriate accuracy, but the utility of its use in the clinical diagnostic algorithm of suspected PJI needs further evidence.

importância de leucócitos marcados no diagnóstico por imagem em infecções articulares periprotéticas / The value of labeled leukocytes imaging for periprosthetic joint infection diagnosis

“…Assim, essa técnica consegue encontrar com eficiência as estruturas anatômicas irregulares perto de regiões com atividade intensa de leucócitos, permitindo avaliações anatômicas e funcionais em uma mesma imagem, ideal para um diagnóstico preciso (20) .…”

“…Apesar disso, deve-se sempre levar em consideração o aumento na exposição do paciente à radiação (12) . A ciência da localização anatômica e a extensão da infecção com maior exatidão possível, permitida pelo SPECT/CT, é de suma importância, pois interfere diretamente na decisão terapêutica (20) . Uma técnica apontada como alternativa a CLM é a cintilografia de antigranulócitos.…”