<scp>PET</scp>/<scp>CT</scp> to detect adverse reactions to metal debris in patients with metal‐on‐metal hip arthroplasty: an exploratory prospective study

Aro, Erik; Seppänen, Marko; Mäkelä, Keijo; Luoto, Pauliina; Roivainen, Anne; Aro, Hannu T.

doi:10.1111/cpf.12493

Cited by 8 publications

(4 citation statements)

References 39 publications

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“…We cannot exclude that this definition might have contributed to the high sensitivity and low specificity of 18 F-FDG PET/CT observed in the current study. It should be also kept in mind that adverse reactions to metal debris can result in an increased 18 F-FDG uptake that is indistinguishable from that occurring at foci of infection [14]. In a previous study that used similar criteria for positive findings, the sensitivity and specificity for infected hip arthroplasties were 100% and 44.8%, respectively [15].…”

Section: Discussionmentioning

confidence: 99%

“…Intriguingly, preliminary data on the potential usefulness of 68 Ga-citrate PET for identifying patients with bone infections have been promising [13]. In a head-to-head comparison, 18 F-FDG PET/CT has been superior to 68 Ga-citrate PET/CT for diagnosing inflammatory reactions elicited by metal debris [14]. However, the question as to whether 68 Ga-citrate PET/CT is either superior or may offer complimentary information to 18 F-FDG PET/CT in detecting lower limb prosthesis infections remains open.…”

Section: Introductionmentioning

confidence: 99%

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Potential usefulness of 68Ga-citrate PET/CT in detecting infected lower limb prostheses

et al. 2019

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BackgroundProsthetic joint infections may lead to failures of total joint arthroplasty. Radionuclide imaging can play a diagnostic role in identifying such infections, which require two-stage exchange arthroplasty (instead of simple revision surgery performed in non-infected cases). Although 18F-FDG PET/CT has emerged as a novel diagnostic tool in this setting, the clinical usefulness of 68Ga-citrate PET/CT has not been previously investigated. This single-center prospective study was designed to address this issue.MethodsBetween January 2016 and October 2017, we examined 34 patients with clinically proven or suspected prosthetic hip/knee joint infections scheduled to undergo surgery. All patients underwent 68Ga-citrate PET/CT scans and sequential 18F-FDG PET/CT imaging for comparative purposes. Intraoperative findings and the results of microbiological analyses of surgical specimens served as gold standard. The diagnostic results were examined according to (1) image interpretation based on radiotracer uptake patterns and (2) quantitative analysis using volumes of interest (VOIs) to calculate standard uptake values (SUVs) and metabolic volumes (MVs).ResultsA total of 26 (76%) patients were diagnosed as having infections. Based on radiotracer uptake pattern criteria, the sensitivity, specificity, and accuracy of 68Ga-citrate PET/CT and 18F-FDG PET/CT were 92%, 88%, and 91% and 100%, 38%, and 85%, respectively. MV was significantly higher in the infected group when 68Ga-citrate PET/CT was used (422.45 vs. 303.65 cm3, p = 0.027), whereas no significant differences were observed on 18F-FDG PET/CT. According to receiver operating characteristic (ROC) curve analysis, a cut-off value of 370.86 for MV resulted in a sensitivity of 61.5% and a specificity of 87.5% (area under curve: 0.75, 95% confidence interval: 0.57–0.88, p = 0.035).ConclusionsSubject to future confirmation, our data provide preliminary evidence that 68Ga-citrate PET/CT may have a complimentary role to 18F-FDG PET/CT in detecting prosthetic joint infections, being characterized by a higher specificity and the possibility to discriminate between an infectious condition and sterile inflammation.Trial registrationThis prospective study was registered at clinicaltrials.gov (registration number: NCT02855190).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potential usefulness of 68Ga-citrate PET/CT in detecting infected lower limb prostheses

et al. 2019

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“…In Mycobacterium tuberculosis, 68 Ga citrate showed better lesion detection of intracranial lesions, due to the absence of tracer accumulation in the brain [62]. Moreover, studies have suggested 68 Ga citrate is less likely to accumulate in post-infective lesions after treatment of the different infections [62][63][64]. Large multi-centred prospective studies are needed to investigate the use of 68 Ga citrate in fungi for these indications.…”

Section: Pet Labelled Antifungal Agentsmentioning

confidence: 99%

Radionuclide Imaging of Fungal Infections and Correlation with the Host Defense Response

Ankrah

Sathekge

Dierckx

et al. 2021

JoF

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The human response to invading fungi includes a series of events that detect, kill, or clear the fungi. If the metabolic host response is unable to eliminate the fungi, an infection ensues. Some of the host response’s metabolic events to fungi can be imaged with molecules labelled with radionuclides. Several important clinical applications have been found with radiolabelled biomolecules of inflammation. 18F-fluorodeoxyglucose is the tracer that has been most widely investigated in the host defence of fungi. This tracer has added value in the early detection of infection, in staging and visualising dissemination of infection, and in monitoring antifungal treatment. Radiolabelled antimicrobial peptides showed promising results, but large prospective studies in fungal infection are lacking. Other tracers have also been used in imaging events of the host response, such as the migration of white blood cells at sites of infection, nutritional immunity in iron metabolism, and radiolabelled monoclonal antibodies. Many tracers are still at the preclinical stage. Some tracers require further studies before translation into clinical use. The application of therapeutic radionuclides offers a very promising clinical application of these tracers in managing drug-resistant fungi.

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“…Despite this, our study showed that 68 Ga-citrate-PET/CT detected abnormal tracer uptake in all the patients who had TB. Another study evaluated the characteristics of 18 F-FDG and 68 Ga-citrate PET/CT in a condition characterized by a severe inflammatory process with necrosis due to the reaction to metal debris in patients with metal on metal hip arthroplasties [25]. 18 F-FDG PET/CT showed periprosthetic uptake in 94 % (15/16) of hip arthroplasties with 68 Ga-citrate showing periprosthetic uptake in only 19 % (3/16).…”

Section: ▶Fig 3 a 18 F-fdg And B 68mentioning

confidence: 99%

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

et al. 2019

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18F-FDG and 68Ga-citrate PET/CT have both been shown to be useful in the management of tuberculosis (TB). We compared the abnormal PET findings of 18F-FDG- and 68Ga-citrate-PET/CT in patients with TB. Methods Patients with TB on anti-TB therapy were included. Patients had a set of PET scans consisting of both 18F-FDG and 68Ga-citrate. Abnormal lesions were identified, and the two sets of scans were compared. The scan findings were correlated to the clinical data as provided by the attending physician. Results 46 PET/CT scans were performed in 18 patients, 11 (61 %) were female, and the mean age was 35.7 ± 13.5 years. Five patients also had both studies for follow-up reasons during the use of anti-TB therapy. Thirteen patients were co-infected with HIV. 18F-FDG detected more lesions than 68Ga-citrate (261 vs. 166, p < 0.0001). 68Ga-citrate showed a better definition of intracerebral lesions due to the absence of tracer uptake in the brain. The mean SUVmax was higher for 18F-FDG compared to 68Ga-citrate (5.73 vs. 3.01, p < 0.0001). We found a significant correlation between the SUVmax of lesions that were determined by both tracers (r = 0.4968, p < 0.0001). Conclusion Preliminary data shows 18F-FDG-PET detects more abnormal lesions in TB compared to 68Ga-citrate. However, 68Ga-citrate has better lesion definition in the brain and is therefore especially useful when intracranial TB is suspected.

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PET/CT to detect adverse reactions to metal debris in patients with metal‐on‐metal hip arthroplasty: an exploratory prospective study

Cited by 8 publications

References 39 publications

Potential usefulness of 68Ga-citrate PET/CT in detecting infected lower limb prostheses

Potential usefulness of 68Ga-citrate PET/CT in detecting infected lower limb prostheses

Radionuclide Imaging of Fungal Infections and Correlation with the Host Defense Response

Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

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PET/CT to detect adverse reactions to metal debris in patients with metal‐on‐metal hip arthroplasty: an exploratory prospective study

Cited by 8 publications

References 39 publications

Potential usefulness of 68Ga-citrate PET/CT in detecting infected lower limb prostheses

Potential usefulness of 68Ga-citrate PET/CT in detecting infected lower limb prostheses

Radionuclide Imaging of Fungal Infections and Correlation with the Host Defense Response

﻿Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis

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Comparison of Fluorine(18)-fluorodeoxyglucose and Gallium(68)-citrate PET/CT in patients with tuberculosis