The usefulness of 99mTc sulfur colloid bone marrow scintigraphy combined with 111In leucocyte scintigraphy in prosthetic joint infection.
OBJECTIVE
To assess the extent to which bone marrow scintigraphy (BMS) makes the interpretation of leucocyte scintigraphy (LS) easier and improves its diagnostic value.


METHODS
Seventy-three 111In LSs, 99mTc hydroxymethylene diphosphonate bone scintigraphies (BSs) and 99mTc sulfur colloid BMSs were performed in 60 patients with suspected infection related to a hip prosthesis or knee prosthesis, either in situ (+group, n = 43) or after removal for septic loosening (-group, n = 30). Bacteriological samples were obtained from all patients. LS was interpreted together with BS (LS-BS) or with BMS (LS-BMS) by three independent readers.


RESULTS
The concordance among readers, estimated by the kappa test, was average with LS-BS (kappa/kappam coefficients = 0.58, 0.58 and 0.46, respectively, for the three pairs of readers) and excellent with LS-BMS (kappa/kappam coefficients = 1.00 for the three pairs of readers). With LS-BS, 64/219 interpretations were equivocal whereas only one was equivocal with LS-BMS. Sensitivity, specificity and accuracy of LS-BMS were, respectively, 80%, 94% and 91% in the +group, and 33%, 100% and 93% in the -group.


CONCLUSIONS
We conclude that (1) the interpretation of the results for LS-BMS is very easy, in contrast to LS-BS; (2) the diagnostic value of LS-BMS for detecting infected joint prostheses is good; and (3) additional data are needed to assess the accuracy of LS-BMS when the prosthesis has been removed.
El Espera
Isabelle
I
Department of Nuclear Medicine, University Hospital, Amiens, France. elesper.isabelle@chu-amiens.fr
Blondet
Cyrille
C
Moullart
Véronique
V
Saïdi
Lazhar
L
Havet
Eric
E
Mertl
Patrice
P
Canarelli
Brigitte
B
Schmit
Jean-Luc
JL
Meyer
Marc-Etienne
ME
D000328:Adult; D001853:Bone Marrow / Q000000981:diagnostic imaging*; D006622:Hip Prosthesis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007205:Indium Radioisotopes; D007595:Joint Prosthesis; D007720:Knee Prosthesis; D007962:Leukocytes / Q000000981:diagnostic imaging*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid
D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid