Diagnostic role of PET or PET/CT for prosthetic joint infection: A systematic review and Meta-analysis

Abstract

Objective: We aimed to explore the role of the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) or PET for the detection of periprosthetic infection (PPI) of lower limb arthroplasty through a systematic review and meta-analysis.

Methods: The MEDLINE and EMBASE from the earliest available date of indexing through October 31, 2020, were searched for studies evaluating the diagnostic performance of PET or PET/CT for the detection of PPI of lower limb arthroplasty. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic curves.

Results: Across 25 results of 19 studies (826 patients), the pooled sensitivity for PET or PET/CT was 0.88 (95% CI; 0.80-0.93) with heterogeneity (χ²=119, P=0.00) and a pooled specificity of 0.89 (95% CI; 0.83-0.93) with heterogeneity (χ²2=170, P=0.00). Likelihood ratio syntheses gave an overall positive LR+ of 7.9 (95% CI; 5.1-12.2) and negative LR- of 0.14 (95% CI; 0.08-0.23). The pooled DOR was 57 (95% CI; 31-106).

Conclusion: The PET or PET/CT demonstrated good sensitivity and specificity for the detection of PPI of lower limb arthroplasty. At present, the literature regarding the use of PET or PET/CT for the detection of PPI of lower limb arthroplasty remains still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of PET or PET/CT for the detection of PPI of lower limb arthroplasty.