Quantitative periprosthetic PET/CT

定量假体周围 PET/CT

• 批准号: 7531736
• 负责人: THOMAS F LANG
• 金额: $ 20.39万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-05 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7531736
• 关键词: Affect; Algorithms; Arthroplasty; Caring; Clinical; Complication; Condition; Data; Degenerative polyarthritis; Detection; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic radiologic examination; Differential Diagnosis; Discipline of Nuclear Medicine; Disease; Early Diagnosis; Enrollment; Ensure; Equipment; Failure; Foundations; Goals; Gold; Growth; Hip region structure; Image; Imaging Phantoms; Implant; Infection; Infiltration; Inflammatory; Inflammatory Response; Institution; Joints; Knee; Knee Prosthesis; Laboratories; Lead; Lesion; Location; Longevity; Lytic Metastatic Lesion; Measurement; Measures; Metals; Minority; Morbidity - disease rate; Morphologic artifacts; Multimodal Imaging; Numbers; Operative Surgical Procedures; Osteolysis; Outcome; Pain; Participant; Patients; Pilot Projects; Positron-Emission Tomography; Process; Prosthesis; Public Health; Range; Rate; Replacement Arthroplasty; Research; Scanning; Science; Sensitivity and Specificity; Solid; Source; Specificity; Standards of Weights and Measures; Surgical Management; Techniques; Testing; Thick; Time; Tissues; Tracer; Translating; United States; Work; X-Ray Computed Tomography; arthropathies; attenuation; base; bone; design; early onset; follow-up; improved; in vivo; innovation; knee replacement arthroplasty; mortality; novel; patient safety; prevent; septic; simulation; success; tool; transmission process; uptake; usability

DESCRIPTION (provided by applicant): Of the approximately 350,000 total joint replacements that are currently performed in the U.S. each year, a significant number will require premature revision operation. One of the most challenging diagnostic aspects of the painful implant is the differentiation between aseptic osteolysis, an inflammatory response to infiltration of wear debris, and infection of the tissue surrounding the joint. Current diagnostic techniques such as plain radiography, laboratory and nuclear medicine tests have severe shortcomings. At the same time, failed diagnosis of infection can dramatically worsen the outcome of a revision operation with sharply increased morbidity and mortality, and underestimation of the extent of aseptic osteolysis may lead to wrong timing of the revision. Both Computed Tomography (CT) and Positron Emission Tomography (PET) have been recognized as potential diagnostic alternatives with excellent sensitivity and specificity for both conditions. However, CT suffers from severe image artifacts in the presence of metallic implants that not only render the CT images undiagnostic but also negatively influence the usability of PET data when they are obtained with modern multimodality PET/CT equipment. In a pilot study at our institution on a dedicated imaging phantom, algorithmic reduction of CT metal artifact was shown to be effective for CT-based diagnosis of aseptic osteolysis. The main objective of the proposed research is to extend this work to PET/CT and thereby create a novel one-stop diagnostic tool for both aseptic osteolysis and infection. The experimental focus of this proposal is to build an osteolysis and infection phantom simulator to optimize and test our metal artifact reduction algorithms, and to test the hypothesis that a combination PET/CT scan is more useful than standalone PET in a small study of 20 patients with painful hip or knee prostheses. Furthermore, based on follow-up CT imaging we will for the first time be able to assess progression rates of aseptic osteolysis directly next to the implant. We believe that a novel metal artifact-corrected PET/CT scan will ensure patient safety by providing a differential diagnosis of both aseptic osteolysis and infection and will help improve surgical planning and avoid misdiagnosis of osteolysis and infection with its painful and costly consequences. PUBLIC HEALTH RELEVANCE: Joint replacement with artificial hips and knees has become a very successful surgical choice to treat osteoarthritis and other joint diseases. Because of the large number of patients so treated, the small fraction of implants that develop painful loosening results in a large rate of patients needing to undergo revision surgery. It is important to correctly diagnose the complication causing the pain to ensure optimal patient management and surgical planning. We propose to overcome the technical challenges associated with using X-ray computed tomography for imaging of metallic implants and use the technique in combination with Positron Emission Tomography to provide a novel comprehensive tool for the early diagnosis of the complications that would otherwise lead to implant failure.

描述（由申请人提供）：目前在美国每年进行的大约35万例关节置换术中，有相当一部分需要提前翻修手术。疼痛植入物最具挑战性的诊断方面之一是区分无菌性骨溶解，磨损碎片浸润的炎症反应和关节周围组织感染。目前的诊断技术，如放射平片、实验室和核医学检查都有严重的缺点。同时，感染诊断不清可使翻修手术的结果急剧恶化，发病率和死亡率急剧增加，对无菌性骨溶解程度的低估可能导致错误的翻修时机。计算机断层扫描（CT）和正电子发射断层扫描（PET）已被认为是潜在的诊断选择，对这两种疾病都具有出色的敏感性和特异性。然而，在金属植入物存在时，CT存在严重的图像伪影，这不仅使CT图像无法诊断，而且当使用现代多模态PET/CT设备获得PET数据时，也会对PET数据的可用性产生负面影响。在我们机构的一项关于专用成像幻影的初步研究中，CT金属伪影的算法减少被证明对基于CT的无菌性骨溶解诊断是有效的。本研究的主要目的是将这项工作扩展到PET/CT，从而为无菌性骨溶解和感染创造一种新的一站式诊断工具。本提案的实验重点是建立一个骨溶解和感染幻影模拟器，以优化和测试我们的金属伪影减少算法，并在20例髋关节或膝关节假体疼痛患者的小型研究中验证PET/CT联合扫描比单独PET更有用的假设。此外，基于后续的CT成像，我们将首次能够评估直接靠近植入物的无菌性骨溶解的进展率。我们相信，一种新型的金属伪影校正PET/CT扫描将通过提供无菌性骨溶解和感染的鉴别诊断来确保患者的安全，并有助于改进手术计划，避免骨溶解和感染的误诊，避免其痛苦和昂贵的后果。公共卫生相关性：人工髋关节和膝关节置换已成为治疗骨关节炎和其他关节疾病的一种非常成功的手术选择。由于大量患者接受了这种治疗，一小部分植入物出现疼痛性松动，导致大量患者需要进行翻修手术。正确诊断引起疼痛的并发症对于确保最佳的患者管理和手术计划至关重要。我们建议克服与使用x射线计算机断层扫描进行金属植入物成像相关的技术挑战，并将该技术与正电子发射断层扫描相结合，为早期诊断可能导致植入物失败的并发症提供一种新的综合工具。