18F-FDG PET for Diagnosing Infections in Prosthetic Joints

Kwee, Robert M.; Kwee, Thomas C.

doi:10.1016/j.cpet.2019.11.005

Cited by 17 publications

(8 citation statements)

References 49 publications

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“…For the diagnosis of prosthetic valve endocarditis and CIED infection, the value of [ 18 F]FDG-PET/CT has already been determined and has been incorporated in international guidelines [ 17 , 18 ]. For prosthetic joints and osteosynthesis material, clinical examination proved to be excellent for establishing an infection or rejecting it, obviating the need for [ 18 F]FDG-PET/CT in these patients [ 19 , 20 ]. In patients without prosthetic material, 17.7% of patients had antibiotic treatment modification and all were a direct consequence of our institutional policy to reduce treatment duration or to switch to oral treatment in patients without metastatic infections or without endovascular infections, respectively.…”

Section: Discussionmentioning

confidence: 99%

Individualizing the use of [18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center

et al. 2021

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Purpose [18F]FDG-PET/CT scanning can help detect metastatic infectious foci and reduce mortality in patients with Staphylococcus aureus bacteremia (SAB), but it is unknown if patients with SAB and an indication for prolonged treatment because of possible endovascular, orthopaedic implant, or other metastatic infection still need [18F]FDG-PET/CT. Methods In a retrospective single-center cohort study, we included all consecutive adult patients with SAB between 2013 and 2020 if an [18F]FDG-PET/CT scan was performed and antibiotic treatment was planned for ≥ 6 weeks prior to [18F]FDG-PET/CT. We aimed to identify patients for whom treatment was adjusted due to the results of [18F]FDG-PET/CT, and assessed concordance of [18F]FDG-PET/CT and clinical diagnosis for infected prosthetic material. Results Among 132 patients included, the original treatment plan was changed after [18F]FDG-PET/CT in 22 patients (16.7%), in the majority (n = 20) due to diagnosing or rejecting endovascular (graft) infection. Antibiotic treatment modifications were shortening in 2, iv-oral switch in 3, extension in 13, and addition of rifampicin in 4 patients. Ninety additional metastatic foci based on [18F]FDG-PET/CT results were found in 69/132 patients (52.3%). [18F]FDG-PET/CT suggested vascular graft infection in 7/14 patients who lacked clinical signs of infection, but showed no infection of prosthetic joints or osteosynthesis material in eight patients who lacked clinical signs of such an infection. Conclusion [18F]FDG-PET/CT can help refine treatment for SAB in patients with clinically suspected endovascular infection or vascular grafts, even if 6 weeks treatment is already indicated, but can be safely omitted in other patients who are clinically stable.

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Section: Discussionmentioning

confidence: 99%

Individualizing the use of [18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…Several literature reports showed a sensitivity of 80–100% and specificity of 90–100% of PET/CT in the diagnosis of PPI of hip and knee joints [ 12 , 13 ]. Using special uptake patterns, PET-CT can distinguish between septic and aseptic loosening [ 12 – 14 ]. The pooled sensitivity and specificity in current meta-analyses were 86% and 93% for THR [ 15 ] and 70% and 84% for TKR [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…18 F-FDG uptake in the lateral and medial sides of the acetabular cup, around the neck of the prosthesis, in the proximal or very distal portion of the component can be nonspecific. In TKR, a 18 F-FDG uptake at the bone-prosthesis interface or in the periprosthetic soft tissues is suspicious for prosthesis infection, while a synovial 18 F-FDG uptake is rather non-specific [12]. For this analysis, all available PET-CT scans from enrolled patients were re-evaluated from two independent specialists in nuclear medicine focusing only on detection of additional infectious focus.…”

Section: Methodsmentioning

confidence: 99%

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Use of PET-CT in diagnostic workup of periprosthetic infection of hip and knee joints: significance in detecting additional infectious focus

Roschke

Kluge

Stallkamp

et al. 2021

International Orthopaedics (SICOT)

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Introduction The diagnosis and management of periprosthetic knee and hip infections as well as the identification and management of possible additional infectious foci is of great importance for successful therapy. This study analyses the importance of 18F deoxyglucose PET-CT (PET-CT) in the identification of additional infectious focus and subsequent impact on management of periprosthetic infection (PPI). Material and methods A retrospective analysis of the clinical data and findings in the period from January 2008 to December 2018 was carried out. One hundred and four patients with in-hospital treatment due to PPI of a hip or knee joint were identified and included in this study. All patients underwent a standardized clinical examination and further surgical and antibiotic therapy. The reevaluation of performed PET-CTs was specifically carried out with regard to the local PPI or detection of secondary foci. Results PET-CT successfully verified the PPI in 84.2% of the patients. A total of 78 possible additional foci were detected in PET-CT in 56 (53.8%) of the examined patients. Predilection sites for possible secondary foci were joints (42.3%), pulmonary (15.4%), ear-nose-throat (15.4%), spine (11.5%), and the musculocutaneous tissues (11.5%). Fifty-four positive PET-CT findings were confirmed clinically with need of additional adequate treatment. Conclusion PET-CT is a valuable diagnostic tool to confirm periprosthetic joint infection. At the same time, the whole-body PET/CT may detect additional foci of infection with impact on subsequent treatment strategy. PET was of special value in detecting infections at distant locations far from the primary infected joint in significant number. These distant infection locations can be potential cause of a re-infection. This clearly reflects the need of their diagnosis.

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“…In a single year in the United States, 14.8% of total hip arthroplasty revisions were due to infection [2]. Additionally, approximately, 6% of all hip and knee replacements require revision surgery after 5 years, with 25% of these revision surgeries being attributed to biofilm infections [3]. Biofilm infections in orthopedic implants are a global problem; with increased use of antibiotic treatments and, therefore, antibiotic‐resistant microbes; these hard‐to‐treat infections lead to patient distress, increased morbidity, and high financial costs to both patients and healthcare systems [4].…”

Section: Introductionmentioning

confidence: 99%

Current and novel diagnostics for orthopedic implant biofilm infections: a review

Ronin

Boyer

Alban

et al. 2021

APMIS

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Biofilm infections involving orthopedic implants are a global problem. They contribute to severe complications and mortality, as well as increased use of antibiotic treatments and development of antibiotic‐resistant microorganisms. More than 1 million hip and knee arthroplasties are performed each year in the United States. These hard‐to‐treat infections lead to patient distress, increased morbidity, and high financial costs to both patients and healthcare systems. There is a need to improve the diagnosis of such biofilm infections to allow for earlier detection and treatment. Current diagnostics rely on clinical signs for infections such as loss of function, fever, rubor, patient history of the predisposing condition, persisting infection, failure of antibiotic treatment, and documentation of antibiotic failure. Below, we present a framework which outlines the data gaps in the conventional laboratory techniques used in clinical diagnostics; we also discuss promising novel diagnostic methods which are currently used solely in research. It is critical to assess these novel infection diagnostic techniques and address the data gaps and clinical hesitance preventing application in a clinical setting. Additionally, the combination of conventional and novel diagnostic technologies would streamline the diagnostic process of biofilm infections associated with orthopedic implants.

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18F-FDG PET for Diagnosing Infections in Prosthetic Joints

Cited by 17 publications

References 49 publications

Individualizing the use of [18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center

Individualizing the use of [18F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center

Use of PET-CT in diagnostic workup of periprosthetic infection of hip and knee joints: significance in detecting additional infectious focus

Current and novel diagnostics for orthopedic implant biofilm infections: a review

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