FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses.
FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses.
复制标题
DOI：
10.1097/rlu.0000000000000464
复制
发表时间：
2014-07
影响因子：
10.6
通讯作者：
Alavi A
中科院分区：
文献类型：
--
作者：
Basu S;Kwee TC;Saboury B;Garino JP;Nelson CL;Zhuang H;Parsons M;Chen W;Kumar R;Salavati A;Werner TJ;Alavi A
评估和比较 FDG-PET 与 111In 标记白细胞/99mTc-硫胶体骨髓 (WBC/BM) 联合成像诊断髋关节和膝关节假体感染的价值。在这项前瞻性研究中，纳入了髋关节或膝关节置换术后疼痛的患者，这些患者计划接受假体翻修的临床和诊断评估。通过使用 FDG-PET 和 111In 标记的白细胞/99mTc-硫胶体骨髓扫描对它们进行了研究。本研究已获得 IRB 批准并符合 HIPAA。所有患者均提供了书面知情同意书。总共评估了 134 个髋关节假体和 87 个膝关节假体，怀疑是感染性松动还是非感染性松动。所有 221 个假体均接受了 FDG-PET，而 88 个假体同时进行了 WBC/BM 成像和 FDG-PET。对 88 名患者的 WBC/BM 图像数据的初步分析表明，与 FDG-PET 扫描的结果相比，有一定的结果。此外，一些患者不愿意接受这两种手术，因此参加了这项研究。因此，决定在本研究的其余部分的程序中消除 WBC/BM 成像。做出这一决定的部分原因是标记白细胞产生的大量辐射剂量以及与制备这些标记细胞相关的安全问题。最终诊断基于对 125 个假体手术标本的微生物学检查和关节抽吸，以及对 86 个假体进行 6 个月或更长时间的临床随访。 FDG-PET 在髋关节假体中的敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV) 分别为 81.8%、93.1%、79.4% 和 94.0%，在膝关节假体中分别为 94.7%、88.2%、69.2% 和 98.4%。 WBC/BM 成像在髋关节假体中的敏感性、特异性、PPV 和 NPV 分别为 38.5%、95.7%、71.4% 和 84.6%，在膝关节假体中分别为 33.3%、88.5%、25.0% 和 92.0%。在同时接受 FDG-PET 和 WBC/BM 成像的病例中，髋关节假体中 FDG-PET 的敏感性有较高的趋势 (P=0.0625)，而其他比较并未显示两种成像方式之间存在任何显着差异。根据这项研究，FDG-PET 扫描在检测疼痛的髋关节和膝关节假体感染方面的诊断性能对于常规临床应用来说是最佳的。考虑到 WBC/BM 成像的复杂性和成本以及与此准备相关的相关安全问题，FDG-PET 似乎是评估这些患者的合适替代方案。
To assess and compare the value of FDG-PET to combined 111In-labeled leukocyte/99mTc-sulfur colloid bone marrow (WBC/BM) imaging for diagnosing infection in hip and knee prostheses. In this prospective study, patients with painful hip or knee arthroplasty, who were scheduled to undergo clinical and diagnostic evaluation for prosthesis revision were included. They have been studied by using FDG-PET and 111In-labeled leukocyte/99mTc-sulfur colloid bone marrow scan. This study was IRB approved and HIPAA compliant. All patients provided written informed consent. A total of 134 hip and 87 knee prostheses, suspected of being either infected or non-infectious loosening were evaluated. All 221 prostheses underwent FDG-PET, whereas both WBC/BM imaging and FDG-PET was performed in 88 prostheses. The initial analysis of data from the WBC/BM images demonstrated somewhat results compared to those of FDG-PET scans on 88 patients. Also, some patients were not willing to undergo both procedures and therefore participate in this study. Therefore, a decision was made to eliminate WBC/BM imaging from the procedures for the remainder of this research study. This decision was reached partly due to the significant radiation dose delivered from labeled WBC as well as safety issues related to preparing these labeled cells. Final diagnosis was based on microbiological examinations of the surgical specimens in 125 prostheses and joint aspirations combined with the clinical follow-up of 6 months or more in 86 prostheses. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FDG-PET in hip prostheses were 81.8%, 93.1%, 79.4%, and 94.0%, respectively and in knee prostheses were 94.7%, 88.2%, 69.2%, and 98.4% respectively. The sensitivity, specificity, PPV, and NPV of WBC/BM imaging in hip prostheses were 38.5%, 95.7%, 71.4%, and 84.6%, respectively and in knee prostheses were 33.3%, 88.5%, 25.0%, and 92.0%, respectively. In those cases that underwent both FDG-PET and WBC/BM imaging, there was a trend (P=0.0625) towards a higher sensitivity for FDG-PET in hip prostheses, whereas other comparisons did not show any significant differences between the two imaging modalities. Based on this study, the diagnostic performance of FDG-PET scan in detecting infection in painful hip and knee prostheses is optimal for routine clinical application. Considering the complexity and costs of WBC/BM imaging and related safety issues associated with this preparation, FDG-PET appears to be an appropriate alternative for assessing these patients.