title: Detection of occult infection following total joint arthroplasty using sequential technetium-99m HDP bone scintigraphy and indium-111 WBC imaging.
abstract: Preoperative exclusion or confirmation of periprosthetic infection is essential for correct surgical management of patients with suspected infected joint prostheses. The sensitivity and specificity of [111In]WBC imaging in the diagnosis of infected total joint prostheses was examined in 28 patients and compared with sequential [99mTc]HDP/[111In]WBC scintigraphy and aspiration arthrography. The sensitivity of preoperative aspiration cultures was 12%, with a specificity of 81% and an accuracy of 58%. The sensitivity of [111In]WBC imaging alone was 100%, with a specificity of 50% and an accuracy of 65%. When correlated with the bone scintigraphy and read as sequential [99mTc]HDP/[111In]WBC imaging, the sensitivity was 88%, specificity 95%, and accuracy 93%. This study demonstrates that [111In]WBC imaging is an extremely sensitive imaging modality for the detection of occult infection of joint prostheses. It also demonstrates the necessity of correlating [111In]WBC images with [99mTc]HDP skeletal scintigraphy in the detection of occult periprosthetic infection.
authors.affiliation: Dept. of Radiology, Vanderbilt University, Nashville, TN 37232.
authors.forename: J A
authors.initials: JA
authors.lastname: Johnson
authors.forename: M J
authors.initials: MJ
authors.lastname: Christie
authors.forename: M P
authors.initials: MP
authors.lastname: Sandler
authors.forename: P F
authors.initials: PF
authors.lastname: Parks
authors.forename: L
authors.initials: L
authors.lastname: Homra
authors.forename: J J
authors.initials: JJ
authors.lastname: Kaye
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000000981:diagnostic imaging*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D007595:Joint Prosthesis; D007962:Leukocytes / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011300:Preoperative Care; D011446:Prospective Studies; D011475:Prosthesis Failure; D011877:Radionuclide Imaging; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives*
chemical_list: D007205:Indium Radioisotopes; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013669:Technetium Tc 99m Medronate