What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?

Segura, Ana; Muñoz, Antonio; Brulles, Y. R.; Hermoso, José Antonio Hernández; Diaz, Maria Carmen G.; Lázaro, M.T. Bajén; Martín-Comín, J.

doi:10.1097/00006231-200405000-00016

Cited by 52 publications

(28 citation statements)

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“…99m Tc-MDP bone scintigraphy has been the most extensively examined radionuclide study for a painful joint replacement (14). Although increased periprosthetic uptake on a bone scan is suggestive of infection, other conditions including trauma, fractures, tumors, heterotopic ossification, and inflammatory disorders can result in an increased uptake in the periprosthetic tissue and may cause false-positive results.…”

Section: Discussionmentioning

confidence: 99%

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

Lorberboym¹,

Feldbrin²,

Hendel³

et al. 2009

J Nucl Med

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The aim of this study was to assess the pattern of annexin V uptake in hip and knee prostheses suspected of being infected. Methods: A total of 7 patients undergoing revision surgery for hip or knee prostheses were studied; 5 patients had total hip replacements, and 2 had total knee replacements. Infection was confirmed by pathology, culture results, laboratory evaluation, and clinical follow-up. All patients also underwent a bone scan before surgery. Results: Annexin V scan findings were positive in 5 patients and negative in 2. Annexin V uptake was either focal (n 5 4) or linear (n 5 1). There were 4 true-positive, 2 true-negative, 1 false-positive, and no false-negative annexin V studies. Annexin V uptake was either more extensive or less extensive than, and usually was incongruent with, 99m Tc-methylene diphosphonate uptake. Conclusion: Our findings suggest that annexin V imaging shows greater uptake with infection than with aseptic loosening and has a high negative predictive value for prosthetic infection.Key Words: apoptosis; annexin V; hip; knee; prosthesis; loosening; infection Nucl Med 2009; 50:534-537 DOI: 10.2967/jnumed.108.059345 Asept ic loosening, an event that occurs months to years after surgery, is the most frequent cause of prosthetic joint failure (1). A less common but far more serious source of joint implant loosening is periprosthetic infection with Staphylococcus aureus, methicillin-resistant S. aureus, Staphylococcus epidermidis, Streptococcus oralis, Escherichia coli, Enterococcus faecalis, or Pseudomonas aeruginosa (2). Periprosthetic infections also tend to be low-grade and frequently cannot be detected by blood or tissue culture, leaving little clinical information to guide treating physicians. The differentiation of infection from aseptic loosening is important because loosening caused by a periprosthetic infection requires usually at least a 2-stage revision surgery involving the removal of the old implant, debridement, and placement of antibiotic-loaded cement beads in the surgical bed. This treatment is in contrast to the single-stage prosthetic joint-replacement treatment for aseptic loosening, a completely different process believed to be caused by repeated mechanical stress and local host response to the wear debris of high-density polyethylene, metals, and bone cement (1). JBecause the clinical and laboratory signs of bacterial infection (culture-negative) are nonspecific, standard radiologic and nuclear medicine imaging remain essential first steps for the work-up of patients with painful prostheses (3). Radiographs reveal signs of loosening regardless of the presence or absence of bacterial infection. Although MRI or enhanced CT scans generally provide useful information for soft-tissue and bone infections, metallic artifacts from a given prosthetic device greatly interfere with the quality of the images obtained (4). Nuclear medicine techniques include 99m Tc-methylene diphosphonate ( 99m Tc-MDP) bone scanning, 67 Ga imaging, and 111 In-(or 99m Tc-hexamethylpropyleneam...

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Section: Discussionmentioning

confidence: 99%

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

Lorberboym¹,

Feldbrin²,

Hendel³

et al. 2009

J Nucl Med

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“…Reinartz found a mean sensitivity/specificity of 78 % /84 % for diagnosing THR loosening with triple-phase bone scans (Reinartz 2009). It was also concluded, that bone scans of THR's are highly sensitive but not specific (Segura et al, 2004). The lowest sensitivity was found by Zilkens et al with a value of 50 % (Zilkens et al, 1988), while the lowest specificity was 38 % (Ovesen et al, 2003).…”

Section: Scintigraphymentioning

confidence: 96%

“…6). Usually, a two-phase or triple-phase bone scan is generated (Segura et al, 2004). The triple-phase bone scan is an enhancement with a reputation of high sensitivity (Reinartz 2009) and uses gallium scans to improve its specificity (Kraemer et al, 1993).…”

Section: Scintigraphymentioning

confidence: 99%

Current Possibilities for Detection of Loosening of Total Hip Replacements and How Intelligent Implants Could Improve Diagnostic Accuracy

Ruther¹,

Timm²,

Ewald³

et al. 2012

Recent Advances in Arthroplasty

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“…Tc-nanocolloids scintigraphy has also shown high diagnostic accuracy, but with limited clinical application due to advantages of competing modalities (ultrasound, MRI, and bone scintigraphy), mainly their broad availability. PET with 18 F-FDG or 11 C-choline has been studied for imaging of synovial infl ammation and measurement of cell proliferation and has been proved to have high diagnostic accuracy [ 17 ]. Although scintigraphy with either 99m Tc-nanocolloids or bisphosphonates could be employed in the diagnosis of RA at its early stages, its role in the evaluation of response to treatment requires repeated imaging as often as every 6-12 weeks.…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

“…However, recent studies have shown that 67 Ga offers no advantages over 18 F-FDG PET/CT for imaging of infl ammatory diseases; therefore, Ga scintigraphy has been largely replaced by PET/CT for such a purpose [ 26 ].…”

Section: Sarcoidosismentioning

confidence: 99%

Miscellaneous: SPECT and SPECT/CT for Brain and Inflammation Imaging and Radiation Planning

Gholamrezanezhad

2013

Clinical Applications of SPECT-CT

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Combination of SPECT (single-photon emission computed tomography) with CT (computed tomography) provides the opportunity for a direct correlation of anatomic information and functional data and leads to a better localization and defi nition of scintigraphic fi ndings. Besides anatomic referencing, the other advantage of CT co-registration is the attenuation correction capabilities of CT. These advantages together result in a higher specifi city of imaging and a signifi cant reduction in indeterminate fi ndings. This chapter highlights the potential clinical applications of integrated SPECT/CT in neurology, infl ammation imaging, and radiation planning and summarizes future directions for SPECT/CT in these fi elds. SPECT/CT for Inflammation ImagingDepending on the type of suspected disease and the clinical presentation, diagnosis of infl ammatory diseases usually requires laboratory and imaging procedures to confi rm clinical diagnosis. Therefore, the context in which specifi c imaging procedures are needed should be selected as in a case-by-case approach. Cross-sectional imaging modalities, mainly CT and MRI, provide high-quality anatomical details, but structural changes that are developed due to infl ammatory processes are usually nonspecifi c.The role of nuclear medicine imaging procedures, including SPECT/CT and PET (positron emission tomography) imaging using different radiopharmaceuticals, has been specifi cally appreciated in the diagnosis of infection of joint prostheses, infected vascular grafts, and a number of other infl ammatory processes [ 1 -34 ].

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What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?

Abstract: When infection of a prosthesis is suspected the diagnostic procedure should start with a WBC scan followed, if positive, by a BM scan. This procedure reduces the cost, the time required for a diagnosis, and the dose of radiation received by the patient.

Cited by 52 publications

References 6 publications

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

Current Possibilities for Detection of Loosening of Total Hip Replacements and How Intelligent Implants Could Improve Diagnostic Accuracy

Miscellaneous: SPECT and SPECT/CT for Brain and Inflammation Imaging and Radiation Planning

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What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?

Abstract: When infection of a prosthesis is suspected the diagnostic procedure should start with a WBC scan followed, if positive, by a BM scan. This procedure reduces the cost, the time required for a diagnosis, and the dose of radiation received by the patient.

Cited by 52 publications

References 6 publications

The Use of 99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The Use of 99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

Current Possibilities for Detection of Loosening of Total Hip Replacements and How Intelligent Implants Could Improve Diagnostic Accuracy

Miscellaneous: SPECT and SPECT/CT for Brain and Inflammation Imaging and Radiation Planning

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Product

Resources

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The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

The Use of ^99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses