Nuclear arthrography: combined scintigraphic and radiographic procedure for diagnosis of total hip prosthesis loosening.
Radiographic arthrography and bone scintigraphy are common diagnostic procedures used for evaluating total hip prostheses. In this study, both techniques are combined, and nuclear contrast imaging (nuclear arthrography) is added. The efficacy of the procedures is evaluated.


METHODS
After intravenous injection of 99mTc-methylene diphosphonate (MDP), standard radiographic arthrography was performed in 105 patients (107 prostheses). The radiographic contrast medium was mixed with insoluble 111In-colloid (5 MBq/20 ml). After completion of the radiographic arthrography, nuclear arthrography was performed, and multiple-view dualisotope images (111In, 247-keV peak only) were recorded. Images were interpreted by superposition of the 111In image and the corresponding 99mTc-MDP image, the latter serving as a landmark for the position of the prosthesis and osseous structures. Findings at surgery were used as the gold standard.


RESULTS
In both cemented and uncemented acetabular and femoral components, nuclear arthrography performed better than or equal to radiographic arthrography (70%-90% and 60%-75%, respectively). Nuclear arthrography had higher diagnostic accuracy than 99mTc-MDP images alone.


CONCLUSIONS
Nuclear arthrography is a sensitive technique for detection of loosening of prostheses, offering added value over radiographic arthrography and bone scanning alone, especially for evaluation of the femoral component. Radiographic arthrography remains necessary not only for adequate deposition of contrast agents but also for detailed evaluation of osseous structures.
Department of Nuclear Medicine, University Hospital Nijmegen, The Netherlands.
W J
WJ
Oyen
J A
JA
Lemmens
R A
RA
Claessens
J R
JR
van Horn
T J
TJ
Slooff
F H
FH
Corstens
D002484:Cementation; D003102:Colloids; D005069:Evaluation Studies as Topic; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis; D006801:Humans; D007205:Indium Radioisotopes; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D011859:Radiography; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D013669:Technetium Tc 99m Medronate
D003102:Colloids; D007205:Indium Radioisotopes; D007472:Iohexol; D013669:Technetium Tc 99m Medronate