title: The usefulness of 99mTc sulfur colloid bone marrow scintigraphy combined with 111In leucocyte scintigraphy in prosthetic joint infection.
abstract: 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.
authors.affiliation: Department of Nuclear Medicine, University Hospital, Amiens, France. elesper.isabelle@chu-amiens.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: El Espera
authors.forename: Cyrille
authors.initials: C
authors.lastname: Blondet
authors.forename: Véronique
authors.initials: V
authors.lastname: Moullart
authors.forename: Lazhar
authors.initials: L
authors.lastname: Saïdi
authors.forename: Eric
authors.initials: E
authors.lastname: Havet
authors.forename: Patrice
authors.initials: P
authors.lastname: Mertl
authors.forename: Brigitte
authors.initials: B
authors.lastname: Canarelli
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Schmit
authors.forename: Marc-Etienne
authors.initials: ME
authors.lastname: Meyer
mesh_terms: 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
chemical_list: D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid