title: Use of 18F-fluoride PET to determine the appropriate tissue sampling region for improved sensitivity of tissue examinations in cases of suspected periprosthetic infection after total hip arthroplasty.
abstract: OBJECTIVE
  The accurate diagnosis of periprosthetic infection requires assessment of intraoperative tissues. These must be sampled from the appropriate sites. We used (18)F-fluoride positron emission tomography (PET) to identify sites of inflammation in order to improve the sensitivity of histopathology, microbiological culture, and real-time PCR in total hip arthroplasty (THA) patients.
  
  
  METHODS
  23 THA patients (23 hips) scheduled for revision surgery (the revision group) and 17 uninfected THA patients (23 hips; control group) were enrolled. Uptake was classified into major, minor, and no uptake. To evaluate the association between the (18)F-fluoride uptake and intraoperative tissue results in the revision group, we calculated their sensitivity on each of the major, minor, and no-uptake sides.
  
  
  RESULTS
  17 revision patients showed major uptake and all were diagnosed as having septic loosening from intraoperative tissue results. Minor uptake was observed in the other 6 revision patients and all were diagnosed as having aseptic loosening. Apart from 3 cases that showed minor uptake regions, control subjects showed no uptake. In the revision group, the sensitivities of histopathology, microbiological culture, real-time PCR separately and also in combination were 0.78, 0.58, 0.96, and 0.96, respectively, on the major (18)F-fluoride uptake sides, 0.0, 0.0, 0.1, and 0.1 on the minor-uptake sides, and 0, 0, 0.18, and 0.18 on the no-uptake sides.
  
  
  CONCLUSIONS
  Our findings suggest that preoperative assessment of major uptake of (18)F-fluoride markedly improves the accuracy of tissue sampling, and thus the sensitivity of subsequent tissue examinations. More definitive diagnosis of periprosthetic infection is therefore possible.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Yokohama City University, Yokohama, Japan. yute@yhc.att.ne.jp
authors.forename: Hyonmin
authors.initials: H
authors.lastname: Choe
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Inaba
authors.forename: Naomi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ike
authors.forename: Chie
authors.initials: C
authors.lastname: Aoki
authors.forename: Kazuya
authors.initials: K
authors.lastname: Shizukuishi
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Iwamoto
authors.forename: Yohei
authors.initials: Y
authors.lastname: Yukizawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishida
authors.forename: Tomio
authors.initials: T
authors.lastname: Inoue
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Saito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D012086:Reoperation; D012680:Sensitivity and Specificity
chemical_list: D005462:Fluorine Radioisotopes