Diagnosing fracture-related infections: can we optimize our nuclear imaging techniques?

“…There is still lack of sufficient evidence to conclude which one is the optimal in detecting FRI. In the future, innovative techniques should be developed, such as imaging techniques being able to detect bacterial biofilms, bone viability, and drug-resistant bacteria [ 36 ].…”

Section: Diagnosismentioning

confidence: 99%

Current Concepts of Fracture-Related Infection

Jiang

2023

International Journal of Clinical Practice

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Currently, fracture-related infection (FRI) still represents great challenges in front of orthopaedic surgeons, despite great advances that have been achieved regarding its diagnosis and treatment. Although both FRI and prosthetic joint infection (PJI) belong to osteoarticular infections and share similarities, FRI displays unique characteristics. Diagnosis of FRI is sometimes difficult owing to the nonspecific symptoms, and treatment is usually tricky, with a high risk of infection recurrence. In addition, the long disease course is associated with a significantly elevated risk of disability, both physically and psychologically. Moreover, such a disorder still poses heavy economic burdens to the patients, both personally and socially. Therefore, early diagnosis and reasonable treatment are the key issues for increasing the cure rate, decreasing the risks of infection relapse and disability, and improving the life quality and prognosis of the patients. In this review, we summarized the present concepts regarding the definition, epidemiology, diagnosis, and treatment of FRI.

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“…Diagnosing fracture-related infection (FRI) can be challenging, and several diagnostic imaging modalities have been proposed [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. White blood cell (WBC) scintigraphy has been proven to be accurate in diagnosing infections of both bone and soft tissue.…”

Section: Introductionmentioning

confidence: 99%

“…A recent retrospective study from our study group analyzed the accuracy of WBC scintigraphy in 192 patients with suspected FRI using the current acquisition and interpretation guidelines and found a diagnostic accuracy of 92% using qualitative (visual) assessment [ 6 ]. Results of other studies are difficult to compare due to substantial heterogeneity in protocols for image acquisition and interpretation [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

White Blood Cell Scintigraphy for Fracture-Related Infection: Is Semiquantitative Analysis of Equivocal Scans Accurate?

et al. 2021

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Purpose: White blood cell (WBC) scintigraphy is considered the gold-standard nuclear imaging technique for diagnosing fracture-related infection (FRI). Correct interpretation of WBC scans in FRI is important since a false positive or false negative diagnosis has major consequences for the patient in terms of clinical decision-making. The European Association of Nuclear Medicine (EANM) guideline for correct analysis and interpretation of WBC scans recommends semiquantitative analysis of visually equivocal scans. Therefore, this study aims to assess the diagnostic accuracy of semiquantitative analysis of visually equivocal WBC scans for diagnosing FRI. Methods: A retrospective single-center study was performed in consecutive patients who received WBC scintigraphy in the diagnostic work-up for FRI between February 2012 and January 2017. All the visually equivocal scans were analysed using semiquantitative analysis by comparing leukocyte uptake in the manually selected suspected infection focus with the contralateral bone marrow (L/R ratio). Cut-off points for a ‘positive’ scan result of >0%, >10% and >20% leukocyte increase between the early and late scans were used in separate analyses. The discriminative ability was quantified by calculating the sensitivity, specificity and diagnostic accuracy. Results: In total, 153 WBC scans were eligible for inclusion. After visual assessment of all the scans, 28 visually equivocal scans were included. Dichotomization of the ratios using the cut-off of >0% resulted in a sensitivity of 30%, a specificity of 45% and a diagnostic accuracy of 40%. The >10% cut-off point resulted in a sensitivity of 18%, a specificity of 82% and a diagnostic accuracy of 66%. The >20% cut-off point resulted in a sensitivity of 0%, a specificity of 89% and a diagnostic accuracy of 67%. Conclusion: Semiquantitative analysis of visually equivocal WBC scans is insufficient for correctly diagnosing FRI.

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Diagnosing fracture-related infections: can we optimize our nuclear imaging techniques?

Cited by 10 publications

References 18 publications

The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review

The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review

Current Concepts of Fracture-Related Infection

White Blood Cell Scintigraphy for Fracture-Related Infection: Is Semiquantitative Analysis of Equivocal Scans Accurate?

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