[Potential use of bone marrow scintigraphy in suspected prosthetic hip infection evaluated with 99mTc-HMPAO-leukocytes].
OBJECTIVE
To evaluate the usefulness of (99m)Tc-Sulphur colloid when combined with leukocyte scintigraphy in suspected prosthetic hip infection, comparing the results with information from (99m)Tc-HMPAO-leukocyte scintigraphy alone.


METHODS
Seventy patients (42 women, 28 men; mean age 68 +/- 13 years) with painful hip prostheses and suspicion of infection were evaluated prospectively. All patients had bone scintigraphy, (99m)Tc-HMPAO-labelled white blood cell scintigraphy and (99m)Tc-Sulphur colloid bone marrow scintigraphy. ESR and CRP levels were measured in all patients. The final diagnosis was made with microbiological findings or by clinical follow up of at least 12 months.


RESULTS
Infections were diagnosed in 12 of the 70 patients (3 coagulase-negative Staphylococcus, 2 Staphylococcus aureus, 2 Staphylococcus epidermidis, 2 enterococcus and 3 polymicrobial agents). ESR and CRP values were higher in patients with infection than in patients without infection (51.8 +/- 29.4 vs. 25.4 +/- 16.4 and 2.8 +/- 2.2 vs. 1.1 +/- 1.3, respectively; p < 0.05). Bone scintigraphy did not show a characteristic pattern to differentiate infection from aseptic loosening. The pool phase of the bone scintigraphy was positive in only 3/12 patients with infection (25 %). Sensitivity and specificity of the leukocyte scintigraphy was 83 % and 57 %, respectively. When the results of the bone marrow scintigraphy were added, these values increased to 92 % and 98 %, respectively.


CONCLUSIONS
Performing bone marrow scintigraphy significantly improves results when compared with leukocyte scintigraphy alone in the diagnosis of infected hip prostheses. Bone scintigraphy did not help to differentiate aseptic loosening from infection in this series.
Fuster
D
D
Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España. dfuster@clinic.ub.es
Duch
J
J
Soriano
A
A
García
S
S
Setoain
X
X
Bori
G
G
Rubí
S
S
Rodríguez
D
D
Doménech
B
B
Piera
C
C
Mensa
J
J
Pons
F
F
D000368:Aged; D000369:Aged, 80 and over; D001799:Blood Sedimentation; D001853:Bone Marrow / Q000000981:diagnostic imaging*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging*; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000209:etiology; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D019690:Technetium Tc 99m Exametazime; D013671:Technetium Tc 99m Sulfur Colloid
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D013671:Technetium Tc 99m Sulfur Colloid; D002097:C-Reactive Protein