Simultaneous 18F-FDG-PET/MRI for the detection of periprosthetic joint infections after knee or hip arthroplasty: a prospective feasibility study

Abstract

Purpose This study investigated the diagnostic value of simultaneous 18F-fluordeoxyglucose positron emission tomography/magnetic resonance imaging (PET/MRI) in suspected periprosthetic joint infection (PJI) of the hip and knee. Methods Sixteen prostheses from 13 patients with suspected PJI were prospectively examined using PET/MRI. Image datasets were evaluated in consensus by a radiologist and a nuclear physician for the overall diagnosis of ‘PJI’ (yes/no) and its anatomical involvement, such as the periprosthetic bone margin, bone marrow, and soft tissue. The imaging results were compared with the reference standard obtained from surgical or biopsy specimens and subjected to statistical analysis. Results Using the reference standard, ten out of the 13 prostheses (ten hips, threes knees) were diagnosed with PJI. Using PET/MRI, every patient with PJI was correctly diagnosed (sensitivity, 100%; specificity, 100%). Considering the anatomical regions, the sensitivity and specificity were 57% and 50% in the periprosthetic bone margin, 75% and 33% in the bone marrow, and 100% and 100% in the soft tissue. Conclusion PET/MRI can be reliably used for the diagnosis of PJI. However, assessment of the periprosthetic bone remains difficult due to the presence of artefacts. Thus, currently, this modality is unlikely to be recommended in clinical practice.

Positron Emission Tomography-Computed Tomography and Magnetic Resonance Imaging Assessments in a Mouse Model of Implant-Related Bone and Joint Staphylococcus aureus Infection

“…FDG-PET was reported to provide discrimination between aseptic and septic lesions and between postoperative infections and postoperative bone healing ( 25 , 26 ). Moreover, FDG-PET showed superiority over structural techniques ( 20 , 27 ). Nuclear imaging has become an indispensable tool in preclinical research on infections ( 24 ).…”

“…In the present study, we used a radiolucent resorbable material to create a focus of infection that mimicked osteomyelitis. The use of this material improved the image quality, compared to metallic implants, because it prevented the appearance of CT and MR imaging artifacts ( 20 ).…”

Application of Nuclear Medicine Techniques in Musculoskeletal Infection: Current Trends and Future Prospects

“…In PJI, a study conducted by Henkelmann et al [86], evaluated 18F-FDG PET/MRI in 10 patients with suspected PJI of the hip and knee compared with surgical or biopsy specimens. 18F-FDG-PET/MR accurately diagnosed all cases with a sensitivity and specificity of 100%, demonstrating superior performance in soft tissue evaluation compared to periprosthetic bone margin or bone marrow assessments.…”

Imaging of knee osteoarthritis: a review of multimodal diagnostic approach

“…The potential role of PET-MRI in detection of periprosthetic joint infections was investigated in a 2022 prospective study by Henkelmann at all. , with the evidence of sensitivity and specificity for periprosthetic infections higher in the soft tissue (100% and 100%) and decreased values for 57% and 50% in the periprosthetic bone margin (57% and 50%) and bone marrow (75% and 33%); however, these first results, while promising, may not justify the high cost and time involved ( 80 ).…”