The value of 18FDG-PET for the detection of infected hip prosthesis

Abstract

We compared the accuracy of fluorine-18 labelled 2-fluoro-2-deoxy- d-glucose positron emission tomography ((18)FDG PET) with that of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (LS) in the detection of infected hip prosthesis. Seventeen patients with a hip prosthesis suspected for infection were prospectively included and underwent (99m)Tc-methylene diphosphonate bone scintigraphy (BS), LS and an (18)FDG-PET scan within a 2-week period. Seven volunteers with ten asymptomatic hip prostheses were used as a control group and underwent BS and an (18)FDG-PET scan. Bacteriology of samples obtained by surgery or by needle aspiration and/or clinical follow-up for up to 6 months were used as the gold standard. Planar images of BS and LS (4 and 24 h p.i.) were acquired, followed by single-photon emission tomography (SPET) LS images (after 4 h). These images were scored as positive or negative by two experienced readers. The (18)FDG-PET scans of the patients were compared with the tracer distribution pattern in the asymptomatic control group and with BS. A phantom study was performed in order to identify artefacts. For this purpose, three different attenuation correction methods were tested. The combined analysis of the planar BS and LS resulted in a 75% sensitivity and a 78% specificity. The SPET LS images showed a better lesion contrast, resulting in an 88% sensitivity and a 100% specificity, while 24-h planar images were of no additional value. The analysis of PET images alone resulted in an 88% sensitivity and a 78% specificity. The combination of (18)FDG-PET and BS images resulted in an 88% sensitivity and a 67% specificity. Given the presence of small errors near the edge of the metal, which can induce significant artefacts in the corrected emission image, we decided to use the data without attenuation correction. In this preliminary study, (18)FDG-PET scans alone showed the same sensitivity as combined BS and LS, although the specificity was slightly lower.

18FDG-PET: a new diagnostic approach in hip prosthesis infection

“…This last statement is supported by other studies on prostheses, 39,43,50,54 and it had already been disclosed by Love et al (1994), who investigated pulmonary abnormalities, 55 and in studies on the detection of other types of infections. 48,56,57 That is, it would be false to think that the greater the number of uptake areas, the more possibility of infection.…”

EANM/SNMMI Guideline for18F-FDG Use in Inflammation and Infection

“…• Joint prosthetic infections (93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109).…”

FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis

“…However, this article was excluded because less than 15 patients with hip and/or knee prostheses were investigated [32]. Thus, eventually 11 studies [12,13,15,17,19,20,23,24,27,28,30], comprising a total sample size of 635 prostheses, met all inclusion and exclusion criteria, and they were included in this systematic review. The characteristics of the included studies are presented in Tables 3, 4, and 5.…”

“…Reviewing titles and abstracts from PubMed/MEDLINE revealed 20 articles potentially eligible for inclusion [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Reviewing titles and abstracts from Embase revealed 17 articles potentially eligible for inclusion, which were all already identified by the PubMed/MEDLINE search.…”