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. 2022 Mar 10;12(3):681.
doi: 10.3390/diagnostics12030681.

The Role of Nuclear Medicine Imaging with 18F-FDG PET/CT, Combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT in the Evaluation of Patients with Chronic Problems after TKA or THA in a Prospective Study

Ramune Aleksyniene  1 , Victor Iyer  1   2 , Henrik Christian Bertelsen  1 , Majbritt Frost Nilsson  1 , Vesal Khalid  3   4 , Henrik Carl Schønheyder  5 , Lone Heimann Larsen  5 , Poul Torben Nielsen  6 , Andreas Kappel  6 , Trine Rolighed Thomsen  7   8 , Jan Lorenzen  8 , Iben Ørsted  9 , Ole Simonsen  6 , Peter Lüttge Jordal  8 , Sten Rasmussen  3   4
Affiliations

The Role of Nuclear Medicine Imaging with 18F-FDG PET/CT, Combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT in the Evaluation of Patients with Chronic Problems after TKA or THA in a Prospective Study

Ramune Aleksyniene et al. Diagnostics (Basel). .

Abstract

Background: The aim of this prospective study was to assess the diagnostic value of nuclear imaging with 18F-FDG PET/CT (FDG PET/CT), combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT (dual-isotope WBC/bone marrow scan) for patients with chronic problems related to knee or hip prostheses (TKA or THA) scheduled by a structured multidisciplinary algorithm.

Materials and methods: Fifty-five patients underwent imaging with 99mTc-HDP SPECT/CT (bone scan), dual-isotope WBC/bone marrow scan, and FDG PET/CT. The final diagnosis of prosthetic joint infection (PJI) and/or loosening was based on the intraoperative findings and microbiological culture results and the clinical follow-up.

Results: The diagnostic performance of dual-isotope WBC/bone marrow SPECT/CT for PJI showed a sensitivity of 100% (CI 0.74-1.00), a specificity of 97% (CI 0.82-1.00), and an accuracy of 98% (CI 0.88-1.00); for PET/CT, the sensitivity, specificity, and accuracy were 100% (CI 0.74-1.00), 71% (CI 0.56-0.90), and 79% (CI 0.68-0.93), respectively.

Conclusions: In a standardized prospectively scheduled patient group, the results showed highly specific performance of combined dual-isotope WBC/bone marrow SPECT/CT in confirming chronic PJI. FDG PET/CT has an appropriate accuracy, but the utility of its use in the clinical diagnostic algorithm of suspected PJI needs further evidence.

Keywords: FDG PET/CT; bone scan; dual-isotope WBC/bone marrow scan; hybrid imaging; labeled leucocyte imaging; nuclear imaging; periprosthetic infection; prosthetic joint infection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
Diagnostic algorithm for the PRIS study.
Figure A2
Figure A2
Definition of post-operative and post-radionuclide diagnosis.
Figure 1
Figure 1
Three hybrid imaging modalities for the same patient with an infected knee prosthesis. (A) FDG PET/CT (showing high FDG uptake located in distal femoral bone marrow and around cortical bone defects, also around the screws in lateral femoral condyle (arrows)). (B,C) Dual-isotope combined In-labeled leucocyte SPECT/CT (B) and bone marrow SPECT/CT (C) (showing mis-matched focal leucocyte uptake (arrow) in distal femoral bone marrow and around cortical bone defects, also around the screws in lateral femoral condyle). (D,E) Bone scan; static uptake (D), SPECT/CT (E) (showing generally high uptake in bone tissue around the prosthesis and metal fixation both in distal femur and proximal tibia).
Figure 1
Figure 1
Three hybrid imaging modalities for the same patient with an infected knee prosthesis. (A) FDG PET/CT (showing high FDG uptake located in distal femoral bone marrow and around cortical bone defects, also around the screws in lateral femoral condyle (arrows)). (B,C) Dual-isotope combined In-labeled leucocyte SPECT/CT (B) and bone marrow SPECT/CT (C) (showing mis-matched focal leucocyte uptake (arrow) in distal femoral bone marrow and around cortical bone defects, also around the screws in lateral femoral condyle). (D,E) Bone scan; static uptake (D), SPECT/CT (E) (showing generally high uptake in bone tissue around the prosthesis and metal fixation both in distal femur and proximal tibia).
Figure 1
Figure 1
Three hybrid imaging modalities for the same patient with an infected knee prosthesis. (A) FDG PET/CT (showing high FDG uptake located in distal femoral bone marrow and around cortical bone defects, also around the screws in lateral femoral condyle (arrows)). (B,C) Dual-isotope combined In-labeled leucocyte SPECT/CT (B) and bone marrow SPECT/CT (C) (showing mis-matched focal leucocyte uptake (arrow) in distal femoral bone marrow and around cortical bone defects, also around the screws in lateral femoral condyle). (D,E) Bone scan; static uptake (D), SPECT/CT (E) (showing generally high uptake in bone tissue around the prosthesis and metal fixation both in distal femur and proximal tibia).
Figure 2
Figure 2
Three hybrid imaging modalities for the same patient with an infected hip prosthesis. (A-1) and (A-2) FDG PET/CT, showing high FDG uptake in the periprosthetic soft tissue communicating with intraarticular space (red arrows). (B,C) Combined In-labeled leucocyte SPECT/CT (B) and bone marrow SPECT/CT (C) (showing focal leucocyte uptake in the soft tissue (arrows) and mis-matched focal leucocyte uptake in the prosthesis bone interface in the femoral part (arrows). (D,E) Bone scan; static uptake (D), SPECT/CT (E) (showing generally high uptake in bone tissue around the prosthesis in proximal femur).
Figure 2
Figure 2
Three hybrid imaging modalities for the same patient with an infected hip prosthesis. (A-1) and (A-2) FDG PET/CT, showing high FDG uptake in the periprosthetic soft tissue communicating with intraarticular space (red arrows). (B,C) Combined In-labeled leucocyte SPECT/CT (B) and bone marrow SPECT/CT (C) (showing focal leucocyte uptake in the soft tissue (arrows) and mis-matched focal leucocyte uptake in the prosthesis bone interface in the femoral part (arrows). (D,E) Bone scan; static uptake (D), SPECT/CT (E) (showing generally high uptake in bone tissue around the prosthesis in proximal femur).
Figure 3
Figure 3
The uptake on images was registered according to the Gruens zones for femoral component (1–7) (A) and Charnley deLee (B) zones for acetabular component (1–3) for hip prostheses (a) and a custom-made scheme for knee prostheses (b).
Figure 4
Figure 4
Patients excluded from the statistical analysis.
See this image and copyright information in PMC

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