FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection
FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection
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DOI：
10.1007/s00259-013-2597-2
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发表时间：
2014-03-01
影响因子：
9.1
通讯作者：
Kanmaz, Bedii
中科院分区：
文献类型：
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作者：
Aksoy, Sabire Yilmaz;Asa, Sertac;Kanmaz, Bedii
目的由于人口老龄化，对关节置换术的需求迅速增长。尽管异养骨化、骨折和脱位等并发症相对罕见，但区分无菌性松动（关节置换术最常见的并发症）和感染对临床医生来说是一个重大挑战。放射性核素成像是目前选择的成像方式，因为它不受骨科硬件的影响。尽管 FDG PET/CT 成像已广泛用于假体周围感染，但它无法区分无菌性和化脓性炎症。在本研究中，我们旨在评估 FDG PET/CT 和 FDG 标记的白细胞 PET/CT 在假体周围感染诊断中的作用。 方法 对 54 例疼痛关节置换术患者进行检查，通过 FDG PET/CT 成像诊断假体周围感染，其中 46 例（36 名女性，10 名男性；平均年龄 61.04 +/- 12.2 岁，范围 32 - 89 岁）的 54 例疼痛关节假体（19 例髋关节，35 例膝关节）在 FDG PET/CT 上具有 2 级（肝脏摄取以上）FDG 积累，该研究纳入了该研究，这 46 名患者还接受了 FDG 标记的白细胞 PET/CT。最终诊断通过组织病理学-微生物培养或临床随访进行。结果最终诊断显示54个假体中15个（28%）存在感染，39个（72%）存在无菌性松动。 FDG PET/CT 的阳性预测值为 28% (15/54)。由于 FDG PET/CT 上未摄取 FDG 的患者被排除在研究之外，因此无法计算敏感性、特异性、阴性预测值和准确性。 FDG标记白细胞PET/CT的敏感性、特异性、阳性预测值和阴性预测值分别为93.3%(14/15)、97.4%(38/39)、93.3%和97.4%。结论由于FDG对感染没有特异性，FDG PET/CT的特异性很低。 FDG标记白细胞PET/CT以其高特异性可能是一种有用的方法，并且在假体周围感染成像中优于标记白细胞闪烁扫描。
Purpose The demand for arthroplasty is rapidly growing as a result of the ageing of the population. Although complications such as heterotrophic ossification, fracture and dislocation are relatively rare, differentiating aseptic loosening, the most common complication of arthroplasty from infection, is a major challenge for clinicians. Radionuclide imaging is currently the imaging modality of choice since it is not affected by orthopaedic hardware. Whereas FDG PET/CT imaging has been widely used in periprosthetic infection, it cannot discriminate aseptic from septic inflammation. In this study we aimed to evaluate the role of FDG PET/CT and FDG-labelled leucocyte PET/CT in the diagnosis of periprosthetic infection.Methods Of 54 patients with painful joint arthroplasty who were imaged by FDG PET/CT for diagnosis of periprosthetic infection examined, 46 (36 women, 10 men; mean age 61.04 +/- 12.2 years, range 32 - 89 years) with 54 painful joint prostheses (19 hip, 35 knee) with grade 2 (above liver uptake) FDG accumulation on FDG PET/CT were included in the study and these 46 patients also underwent FDG-labelled leucocyte PET/CT. Final diagnoses were made by histopathological-microbiological culture or clinical follow-up.Results The final diagnosis showed infection in 15 (28 %) and aseptic loosening in 39 (72 %) of the 54 prostheses. FDG PET/CT was found to have a positive predictive value of 28 % (15/54). Since patients with no FDG uptake on FDG PET/CT were excluded from the study, the sensitivity, specificity, negative predictive value and accuracy could not be calculated. The sensitivity, specificity, and positive and negative predictive values of FDG-labelled leucocyte PET/CT were 93.3 % (14/15), 97.4 % (38/39), 93.3 % and 97.4 %, respectively.Conclusion Since FDG is not specific to infection, the specificity of FDG PET/CT was very low. FDG-labelled leucocyte PET/CT with its high specificity may be a useful method and better than labelled leucocyte scintigraphy in periprosthetic infection imaging.