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. 2018 Dec;89(6):634-639.
doi: 10.1080/17453674.2018.1525931. Epub 2018 Oct 18.

18F-FDG-PET uptake in non-infected total hip prostheses

Stefan J Gelderman  1 , Paul C Jutte  2 , Ronald Boellaard  1 , Joris J W Ploegmakers  2 , David Vállez García  1 , Greetje A Kampinga  3 , Andor W J M Glaudemans  1 , Marjan Wouthuyzen-Bakker  3
Affiliations

18F-FDG-PET uptake in non-infected total hip prostheses

Stefan J Gelderman et al. Acta Orthop. 2018 Dec.

Abstract

Background and purpose - 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used in the diagnostic work-up of a patient with suspected periprosthetic joint infection (PJI) but, due to a lack of accurate interpretation criteria, this technique is not routinely applied. Since the physiological uptake pattern of FDG around a joint prosthesis is not fully elucidated, we determined the physiological FDG uptake in non-infected total hip prostheses. Patients and methods - Patients treated with primary total hip arthroplasty (1995-2016) who underwent a FDG-PET/CT for an indication other than a suspected PJI were retrospectively evaluated. Scans were both visually and quantitatively analyzed. Semi-quantitative analysis was performed by calculating maximum and peak standardized uptake values (SUVmax and SUVpeak) by volume of interests (VOIs) at 8 different locations around the prosthesis. Results - 58 scans from 30 patients were analyzed. In most hips, a diffuse heterogeneous uptake pattern around the prosthesis was observed (in 32/38 of the cemented prostheses, and in 16/20 of the uncemented prostheses) and most uptake was located around the neck of the prosthesis. The median SUVmax in the cemented group was 2.66 (95% CI 2.51-3.10) and in the uncemented group 2.87 (CI 2.65-4.63) (Median difference = -0.36 [CI -1.2 to 0.34]). In uncemented prostheses, there was a positive correlation in time between the age of the prosthesis and the FDG uptake (rs = 0.63 [CI 0.26-0.84]). Interpretation - Our study provides key data to develop accurate interpretation criteria to differentiate between physiological uptake and infection in patients with a prosthetic joint.

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Figures

Figure 1.
Figure 1.
Flow chart of the patient inclusion process.
Figure 2.
Figure 2.
Example of 18F-FDG uptake in a non-infected total hip prosthesis. (A) Coronal FDG-PET image showing FDG uptake around the prosthesis, most prominent at the lateral side of the collum; (B, C, D) Coronal fused FDG-PET/CT images at different slices showing the uptake around the prosthesis; (E) Transaxial fused FDG-PET/CT image showing prominent physiological uptake at the lateral side of the cup of the prosthesis.
Figure 3.
Figure 3.
The relationship between the mean SUVmax and the age of the prosthesis in cemented (left panel) and uncemented hip prostheses (right panel).
See this image and copyright information in PMC

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