Critical Role of 18F-Labeled Fluorodeoxyglucose PET in the Management of Patients with Arthroplasty

Zhuang, Hongming; Yang, Hua; Alavi, Abass

doi:10.1016/j.rcl.2007.05.010

Cited by 30 publications

(21 citation statements)

References 60 publications

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“…Sequential bone/gallium scintigraphy, the first generation of scintigraphic imaging techniques introduced for this purpose, has been replaced by combined leucocyte/bone marrow scintigraphy [2]. Despite an accuracy of about 90%, the technique is expensive, time consuming, labour intensive, not widely available and potentially hazardous [80]. Unfortunately, data on FDG PET are rather inconsistent and suggest no additional benefit to conventional nuclear medicine modalities, e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, PET/CT combines PET with a low or conventional dose CT scan and provides excellent anatomical correlation of any areas of uptake which increases the accuracy compared to PET alone. Therefore, FDG PET and PET/CT are emerging as important imaging modalities in the management of patients with painful arthroplasty [80].…”

Section: Spect/ct Bone Leucocyte and Gallium Imaging Modalitiesmentioning

confidence: 99%

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

Gemmel¹,

Wyngaert²,

Love

et al. 2012

Eur J Nucl Med Mol Imaging

170

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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Section: Discussionmentioning

confidence: 99%

Section: Spect/ct Bone Leucocyte and Gallium Imaging Modalitiesmentioning

confidence: 99%

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

Gemmel¹,

Wyngaert²,

Love

et al. 2012

Eur J Nucl Med Mol Imaging

170

151

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“…Uptake pattern seems to be of essential importance in the diagnosis of infection and is defined as very suggestive of infection if the 18F-FDG uptake between the bone and prosthesis at the level of the midshaft portion of the prosthesis is present (23, 24). This suggests that more standardized criteria for the interpretation of the 18F-FDG scan for the diagnosis of infection on the prosthesis placement should be defined and applied in practice.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Pattern of Asymptomatic Hip-Prosthesis by 18F-FDG-Positron-Emission-Tomography

et al. 2014

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Background:Joint replacement is a procedure with a major impact on the quality of life of patients with joint degenerative disease or traumatic injuries. However, some patients develop symptoms after the intervention caused by mechanical loosening or infection. Metabolic imaging by 18F-FDG-PET investigated in these patients isoften hampered by low specificity for diagnosis of possible septic vs. mechanical loosening. The reason for this shortcoming is to our opinion the unawareness of physiological remodeling processes that could be seen in asymptomatic patients.Objectives:In order to overcome this drawback, we aimed to find out the physiological metabolic functional pattern in asymptomatic patients with implanted hip prosthesisPatients and Methods:Twelve patients (6 males, 6 females); mean age 73 ± 7 (range 58 - 91) years were prospectively enrolled in the study. The patients were admitted to our department for oncological referral with implanted hip prostheses. All patients explained no symptoms with regard to their implanted prosthesis. The attenuation corrected images were used for analysis.Results:Fourteen hip prostheses in 12 patients were visually analyzed. Seven out of 14 prostheses among 12 patients showed focal periprosthetic enhanced metabolism, two of which showed two sites of enhanced uptake; whereas, the remaining five prostheses showed singular hypermetabolic areas within the periprosthetic site. The remaining seven prostheses in the other five patients showed no periprosthetic-enhanced uptake.Conclusion:Of the asymptomatic patients investigated, 58% showed focal enhanced periprosthetic glucose metabolism. This finding should be taken into consideration as a more probable unspecific metabolic pattern for correct interpretation of 18F-FDG-PET studies in patients with suspected septic loosening of the hip prosthesis.

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“…The application of 18 F-FDG PET to the detection and management of patients with occult infection is evolving and, to date, has been described in a wide range of clinical conditions including osteomyelitis, pyrexia of unknown origin, pericarditis, vascular graft infections and fistulae, diabetic foot infections, painful lower limb prostheses, and mycotic aneurysms [3, [35][36][37][38][39][40][41][42][43].…”

Section: Pet/ct In Infective Endocarditismentioning

confidence: 99%

What Can We Learn About Valvular Heart Disease From PET/CT?

et al. 2013

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Valvular heart disease is a major cause of morbidity and mortality, and with an aging population, its prevalence is increasing. Here, we review the evolving use of positron emission tomography/computed tomography in valvular heart disease, with particular focus on calcific aortic stenosis and infective endocarditis. In principle, the activity of any pathological process can be studied, as long as an appropriate radiotracer can be developed. We will review some of the early data using established tracers in the above and other conditions, providing discussion as to the future research and clinical roles of these techniques. Furthermore, we will discuss the potential impact of novel tracers that are currently under development or testing in preclinical models. It is hoped that such advanced imaging might improve the diagnosis, treatment and outlook for patients with valvular heart disease.

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Critical Role of 18F-Labeled Fluorodeoxyglucose PET in the Management of Patients with Arthroplasty

Cited by 30 publications

References 60 publications

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

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

Metabolic Pattern of Asymptomatic Hip-Prosthesis by 18F-FDG-Positron-Emission-Tomography

What Can We Learn About Valvular Heart Disease From PET/CT?

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