title: Diagnostic accuracy of combined 99mTc-sulesomab and 99mTc-nanocolloid bone marrow imaging in detecting prosthetic joint infection.
abstract: OBJECTIVE
  Autologous-labeled leukocytes combined with sulfur colloid bone marrow scan is the current nuclear medicine gold standard for the diagnosis of prosthetic joint infection. The goal of this study is to assess the diagnostic accuracy of a new nuclear medicine modality for detecting infection in this context.
  
  
  METHODS
  Twenty-seven patients with suspicious hip and knee arthroplasties were enrolled prospectively and underwent nuclear medicine testing using 99mTc-sulesomab and 99mTc-nanocolloids sequentially. These results were then crossed with the final diagnosis to determine the test(s) diagnostic accuracy.
  
  
  RESULTS
  An isolated 99mTc-sulesomab scan shows 100% sensitivity (0.40-1) and negative predictive value (0.31-1) but only 20% specificity (0.05-0.48). Combining it with a 99mTc-nanocolloid bone marrow scan increases the specificity (0.75-1) and the positive predictive value (0.40-1) to 100%. Furthermore, the combined test has fewer equivocal readings and higher interreader agreement: κ test value 0.59 vs. 0.44.
  
  
  CONCLUSIONS
  The results support the hypothesis that these technically simpler and ready-to-use products may be an alternative to autologous-labeled leukocytes/sulfur colloid marrow scan.
authors.affiliation: Department of Orthopaedic, Centro Hospitalar do Porto, Hospital Santo António, Oporto, Portugal. ricardojgsousa@gmail.com
authors.forename: Ricardo
authors.initials: R
authors.lastname: Sousa
authors.forename: Marta
authors.initials: M
authors.lastname: Massada
authors.forename: Alexandre
authors.initials: A
authors.lastname: Pereira
authors.forename: Flávia
authors.initials: F
authors.lastname: Fontes
authors.forename: Inês
authors.initials: I
authors.lastname: Amorim
authors.forename: António
authors.initials: A
authors.lastname: Oliveira
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001853:Bone Marrow / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D018511:Systems Integration; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; C101172:Sulesomab