An evaluation of the role of nuclear medicine imaging in the diagnosis of periprosthetic infections of the hip

Trevail, C.; Ravindranath-Reddy, P.; Sulkin, Tom; Bartlett, Gavin E

doi:10.1016/j.crad.2015.10.026

Cited by 30 publications

(17 citation statements)

References 26 publications

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“…Unfortunately, only seven patients had a negative bone scan, and timing between surgery and scans was not mentioned. Trevail et al [ 152 ] also investigated an imaging algorithm in 235 consecutive patients, of which only 17 were ultimately diagnosed with a proven infection. The authors also performed an initial bone scan, which, if positive, was followed with a WBC scan.…”

Section: Consensus Statementsmentioning

confidence: 99%

Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement)

Signore

Sconfienza

Borens

et al. 2019

Eur J Nucl Med Mol Imaging

155

115

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Background For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking. Aim and Methods To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart. Results and Conclusion The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM). Electronic supplementary material The online version of this article (10.1007/s00259-019-4263-9) contains supplementary material, which is available to authorized users.

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Section: Consensus Statementsmentioning

confidence: 99%

Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement)

Signore

Sconfienza

Borens

et al. 2019

Eur J Nucl Med Mol Imaging

155

115

View full text Add to dashboard Cite

show abstract

“…Various interpretive criteria were used in earlier studies [13, 14, 16–18, 23]. Some were qualitative in nature (visual comparisons of early and late acquisitions, comparisons between periprosthetic uptake and that of the surrounding bony tissue or the contralateral site) [13, 18].…”

Section: Discussionmentioning

confidence: 99%

The use of labelled leucocyte scintigraphy to evaluate chronic periprosthetic joint infections: a retrospective multicentre study on 168 patients

Blanc

Bonnet

Giordano

et al. 2019

Eur J Clin Microbiol Infect Dis

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Labelled leucocyte scintigraphy (LS) is regarded as helpful when exploring bone and joint infections. The aim of this study was to evaluate the utility of LS for the diagnosis of chronic periprosthetic joint infections (PJIs) in patients exhibiting arthroplastic loosening. One hundred sixty-eight patients were referred to centres for treatment of complex PJI. One hundred fifty underwent LS using 99m Tc-HMPAO (LLS); 18 also underwent anti-granulocyte scintigraphy (AGS) and 13 additional SPECT with tomodensitometry imaging (SPECT-CT). The LS results were compared with bone scan data. For all, the final diagnoses were determined microbiologically; perioperative samples were cultured. LS values were examined, as well as sensitivity by microorganism, anatomical sites, and injected activity. LS results were also evaluated according to the current use of antibiotics or not. The sensitivity, specificity, and positive predictive value of LLS were 72%, 60%, and 80%, respectively. LLS performed better than did AGS. SPECT-CT revealed the accurate locations of infections. The sensitivity of LS was not significantly affected by the causative pathogen or the injected activity. No correlation was evident between the current antibiotic treatment and the LS value. The test was more sensitive for knee (84%) than hip arthroplasty (57%) but was less specific for knee (52% vs. 75%). Sensitivity and specificity of LLS varied by the location of infection bone scan provide no additional value in PJI diagnosis. Current antibiotic treatment seems to have no influence on LS sensitivity as well as labelling leukocyte activity or pathogens responsible for chronic PJI.

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“…The diagnostic standards used in this study were based on the previous literature [4,12,18,20,21], as follows: PJI was diagnosed when the patient met the 2013 Musculoskeletal Infection Society (MSIS) criteria [22], or when at least one of three features was positive (intraoperative ndings including the occurrence of pus or purulent uid around the prosthesis, histological analysis, and surgical microbiological culture); AL was only diagnosed when the patient was excluded from the MSIS criteria and the intraoperative ndings, histological analysis, and microbial culture results were negative. Those who did not meet the MSIS criteria and were not con rmed to have AL through surgery were considered to have insu cient criteria for the diagnosis of AL and were excluded from our cohort.…”

Section: Methodsmentioning

confidence: 99%

Application of [68Ga]Ga-citrate PET/CT for Differentiating Prosthetic Joint Infection from Aseptic Loosening After Joint Replacement Surgery

Yun

Yang

et al. 2020

Preprint

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Purpose Preoperative differentiation of prosthetic joint infection (PJI) and aseptic loosening (AL) is challenging. We aimed to evaluate the utility of visual analysis and semi-quantitative parameters of [68Ga]Ga-citrate positron emission tomography/computed tomography (PET/CT) in the differentiation of PJI and AL. Methods Sixteen patients with suspected PJI or AL underwent [68Ga]Ga-citrate PET/CT imaging. Results were evaluated by three nuclear medicine doctors based on (1) visual analysis of the attenuation correction (AC) and non-attenuation correction (NAC) based on tracer uptake intensity and range; (2) maximum standard uptake value (SUVmax) of lesions and the SUVmax of the target area/SUVmax of the non-target area (bone and muscle; T/NT [bone] and T/NT [muscle]). The final diagnosis was based on the Musculoskeletal Infection Society criteria, intraoperative findings, and histopathological and microbiological examinations. Results Overall, 10 (62.5%) and 6 (37.5%) patients were diagnosed with PJI and AL, respectively. Receiver operating characteristic analysis revealed that the areas under the curve for SUVmax, T/NT (bone), and T/NT (muscle) were 0.617 (cut-off = 2.243, P = 0.4312), 0.850 (cut-off = 2.844, P = 0.0052), and 0.850 (cut-off = 5.983, P = 0.0003), respectively. AC, NAC, and T/NT (bone) exhibited high differential diagnostic values (sensitivity, specificity, and accuracy of 90.0%, 83.3%, and 87.5%, respectively). The diagnostic efficacy of T/NT (muscle) was the second highest (sensitivity, specificity, and accuracy of 60.0%, 100%, and 75.0%, respectively). SUVmax demonstrated the poorest diagnostic efficacy (sensitivity, specificity, and accuracy of 70.0%, 66.7%, and 68.8%, respectively). Conclusion Our results suggest that [68Ga]Ga-citrate may differentiate PJI and AL.

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An evaluation of the role of nuclear medicine imaging in the diagnosis of periprosthetic infections of the hip

Cited by 30 publications

References 26 publications

Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement)

Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement)

The use of labelled leucocyte scintigraphy to evaluate chronic periprosthetic joint infections: a retrospective multicentre study on 168 patients

Application of [68Ga]Ga-citrate PET/CT for Differentiating Prosthetic Joint Infection from Aseptic Loosening After Joint Replacement Surgery

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