title: [Screening with angiographic images prior to (99m)Tc-HMPAO labelled leukocyte scintigraphy in the diagnosis of periprosthetic infection].
abstract: OBJECTIVE
  To evaluate the impact of the angioscintigrapy of the three phase bone scan as screening method to rule out infection of the hip and knee prosthesis prior to performing the (99m)Tc-HMPAO leukocyte scintigraphy.
  
  
  METHODS
  A total of 120 (70 women, 50 men; mean age 71±11years) with clinical suspicion of hip (n=63) or knee (n=57) infection of the prosthesis and clinical suspicion of infection were evaluated prospectively. All patients underwent three-phase bone scan (angioscintigraphy, vascular and bone phase) and (99m)Tc-HMPAO-labelled white blood cell scintigraphy. Final diagnosis of infection was made by microbiological documentation or clinical follow-up for at least 12months.
  
  
  RESULTS
  Eighteen out of 120 patients were diagnosed of infection of hip prosthesis (n=10) or knee prosthesis (n=8). The angioscintigraphy was positive in 15/18 infected cases and in 21/102 of the non-infected cases with a sensitivity of 83%, specificity of 79% and negative predictive value of 97%. Sensitivity and specificity of (99m)Tc-HMPAO leukocyte scintigraphy were 72% and 95%, respectively. If the leukocyte labeled scintigraphies had been used exclusively for patients with positive angioscintigraphy, this would have saved up to 70% of the (99m)Tc-HMPAO leukocyte scintigraphies performed. There were no cases of infection with positive labeled leukocyte scintigraphy and negative angioscintigraphy.
  
  
  CONCLUSIONS
  Angioscintigraphy (blood flow phase of bone scan) is a useful technique for screening for hip and knee joint prosthesis infection, significantly reducing the need for (99m)Tc-HMPAO leukocyte scintigraphy without affecting the sensitivity of the technique.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España. Electronic address: ulgranad@clinic.ub.es.
authors.forename: U
authors.initials: U
authors.lastname: Granados
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España.
authors.forename: D
authors.initials: D
authors.lastname: Fuster
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Soriano
authors.affiliation: Servicio de Traumatología y Ortopedia, Hospital Clínic, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: García
authors.affiliation: Servicio de Traumatología y Ortopedia, Hospital Clínic, Barcelona, España.
authors.forename: G
authors.initials: G
authors.lastname: Bori
authors.affiliation: Servicio de Traumatología y Ortopedia, Hospital Clínic, Barcelona, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Martínez
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Mayoral
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Perlaza
authors.affiliation: Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, España.
authors.forename: X
authors.initials: X
authors.lastname: Tomás
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínic, Barcelona, España.
authors.forename: F
authors.initials: F
authors.lastname: Pons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000209:etiology; D013212:Staphylococcus epidermidis; D019690:Technetium Tc 99m Exametazime
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime
keywords: (99m)Tc-HMPAO-leucocitos; (99m)Tc-HMPAO-leukocyte; Angiogammagrafía; Angioscintigraphy; Cribado; Infección; Joint infection; Joint prosthesis; Prótesis articulares; Screening