title: The value of (18)FDG-PET for the detection of infected hip prosthesis.
abstract: We compared the accuracy of fluorine-18 labelled 2-fluoro-2-deoxy- d-glucose positron emission tomography ((18)FDG PET) with that of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (LS) in the detection of infected hip prosthesis. Seventeen patients with a hip prosthesis suspected for infection were prospectively included and underwent (99m)Tc-methylene diphosphonate bone scintigraphy (BS), LS and an (18)FDG-PET scan within a 2-week period. Seven volunteers with ten asymptomatic hip prostheses were used as a control group and underwent BS and an (18)FDG-PET scan. Bacteriology of samples obtained by surgery or by needle aspiration and/or clinical follow-up for up to 6 months were used as the gold standard. Planar images of BS and LS (4 and 24 h p.i.) were acquired, followed by single-photon emission tomography (SPET) LS images (after 4 h). These images were scored as positive or negative by two experienced readers. The (18)FDG-PET scans of the patients were compared with the tracer distribution pattern in the asymptomatic control group and with BS. A phantom study was performed in order to identify artefacts. For this purpose, three different attenuation correction methods were tested. The combined analysis of the planar BS and LS resulted in a 75% sensitivity and a 78% specificity. The SPET LS images showed a better lesion contrast, resulting in an 88% sensitivity and a 100% specificity, while 24-h planar images were of no additional value. The analysis of PET images alone resulted in an 88% sensitivity and a 78% specificity. The combination of (18)FDG-PET and BS images resulted in an 88% sensitivity and a 67% specificity. Given the presence of small errors near the edge of the metal, which can induce significant artefacts in the corrected emission image, we decided to use the data without attenuation correction. In this preliminary study, (18)FDG-PET scans alone showed the same sensitivity as combined BS and LS, although the specificity was slightly lower.
authors.affiliation: Department of Nuclear Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Vanquickenborne
authors.forename: Alex
authors.initials: A
authors.lastname: Maes
authors.forename: Johan
authors.initials: J
authors.lastname: Nuyts
authors.forename: Frank
authors.initials: F
authors.lastname: Van Acker
authors.forename: Jos
authors.initials: J
authors.lastname: Stuyck
authors.forename: Michiel
authors.initials: M
authors.lastname: Mulier
authors.forename: Alfons
authors.initials: A
authors.lastname: Verbruggen
authors.forename: Luc
authors.initials: L
authors.lastname: Mortelmans
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D005260:Female; D019788:Fluorodeoxyglucose F18; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007962:Leukocytes / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013585:Synovitis / Q000000981:diagnostic imaging / Q000209:etiology; D019690:Technetium Tc 99m Exametazime; D013669:Technetium Tc 99m Medronate; D014055:Tomography, Emission-Computed / Q000295:instrumentation / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D019690:Technetium Tc 99m Exametazime; D013669:Technetium Tc 99m Medronate