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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 01-11-2008 | Review Article

FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis

Authors: Thomas C. Kwee, Robert M. Kwee, Abass Alavi

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2008

Abstract

Purpose

The aim of this study was to systematically review and metaanalyze published data on the diagnostic performance of ¹⁸F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) in detecting prosthetic hip or knee joint infection.

Methods

A systematic search for relevant studies was performed of the PubMed/MEDLINE and Embase databases. Two reviewers independently assessed the methodological quality of each study. A metaanalysis of the reported sensitivity and specificity of each study was performed. Subgroup analyses were performed if results of individual studies were heterogeneous.

Results

The inclusion criteria were met by 11 studies; there was a total sample size of 635 prostheses. Overall, the studies had good methodological quality. Pooled sensitivity and specificity of FDG-PET for the detection of prosthetic hip or knee joint infection were 82.1% (95%CI = 68.0–90.8%) and 86.6% (95%CI = 79.7–91.4%), respectively. Heterogeneity among the results of individual studies was present (I ² = 68.8%). Diagnostic performance was influenced by type of joint prostheses (hip prostheses vs. knee prostheses) and type of reconstruction method used (filtered back vs. iterative) (p = 0.0164 and p = 0.0235, respectively).

Conclusion

In this metaanalysis, overall diagnostic performance of FDG-PET was moderate to high. Caution is warranted, however, because results of individual studies were heterogeneous and could not be fully explored. Future studies should further explore potential causes of heterogeneity and validate the use of FDG-PET for diagnosing prosthetic joint infection.

Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br 2006;88:149–55.PubMed

Barberán J. Management of infections of osteoarticular prosthesis. Clin Microbiol Infect 2006;12(Suppl 3):93–101.PubMedCrossRef

Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 2005;87:1746–51.PubMedCrossRef

Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 1999;48:111–22.PubMed

Love C, Tomas MB, Marwin SE, Pugliese PV, Palestro CJ. Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics 2001;21:1229–38.PubMed

Kelly S, Berry E, Roderick P, Harris KM, Cullingworth J, Gathercole L, et al. The identification of bias in studies of the diagnostic performance of imaging modalities. Br J Radiol 1997;70:1028–35.PubMed

Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25.PubMedCrossRef

Whiting PF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PN, Kleijnen J. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol 2006;6:9.PubMedCrossRef

Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 2003;56:1129–35.PubMedCrossRef

10.

Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005;58:982–90.PubMedCrossRef

11.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60.PubMedCrossRef

12.

Chryssikos T, Parvizi J, Ghanem E, Newberg A, Zhuang H, Alavi A. FDG-PET imaging can diagnose periprosthetic infection of the hip. Clin Orthop Relat Res 2008;466:1338–42.PubMedCrossRef

13.

García-Barrecheguren E, Rodríguez Fraile M, Toledo Santana G, Valentí Nín JR, Richter Echevarría JA. FDG-PET: a new diagnostic approach in hip prosthetic replacement. Rev Esp Med Nucl 2007;26:208–20.PubMedCrossRef

14.

Stumpe KD, Romero J, Ziegler O, Kamel EM, von Schulthess GK, Strobel K, et al. The value of FDG-PET in patients with painful total knee arthroplasty. Eur J Nucl Med Mol Imaging 2006;33:1218–25.PubMedCrossRef

15.

Pill SG, Parvizi J, Tang PH, Garino JP, Nelson C, Zhuang H, et al. Comparison of fluorodeoxyglucose positron emission tomography and (111)indium-white blood cell imaging in the diagnosis of periprosthetic infection of the hip. J Arthroplasty 2006;21(Suppl 2):91–7.PubMedCrossRef

16.

Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am 2006;88(Suppl 4):138–47.PubMedCrossRef

17.

Delank KS, Schmidt M, Michael JW, Dietlein M, Schicha H, Eysel P. The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: results from a prospective, blinded study. BMC Musculoskelet Disord 2006;7:20.PubMedCrossRef

18.

Mumme T, Reinartz P, Alfer J, Müller-Rath R, Buell U, Wirtz DC. Diagnostic values of positron emission tomography versus triple-phase bone scan in hip arthroplasty loosening. Arch Orthop Trauma Surg 2005;125:322–9.PubMedCrossRef

19.

Reinartz P, Mumme T, Hermanns B, Cremerius U, Wirtz DC, Schaefer WM, et al. Buell U. Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. J Bone Joint Surg Br 2005;87:465–70.PubMedCrossRef

20.

Stumpe KD, Nötzli HP, Zanetti M, Kamel EM, Hany TF, Görres GW, et al. FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology 2004;231:333–41.PubMedCrossRef

21.

Cremerius U, Mumme T, Reinartz P, Wirtz D, Niethard FU, Büll U. Analysis of (18)F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty. Nuklearmediziner 2003;42:234–9.

22.

Mumme T, Reinartz P, Cremerius U, Hermanns B, Müller-Rath R, Neuss M, et al. [F-18]-fluorodeoxyglucose (FDG) positron emission tomography (PET) as a diagnostic for hip endoprosthesis loosening. Z Orthop Ihre Grenzgeb 2003;141:540–6.PubMedCrossRef

23.

Chacko TK, Zhuang H, Nakhoda KZ, Moussavian B, Alavi A. Applications of fluorodeoxyglucose positron emission tomography in the diagnosis of infection. Nucl Med Commun 2003;24:615–24.PubMedCrossRef

24.

Vanquickenborne B, Maes A, Nuyts J, Van Acker F, Stuyck J, Mulier M, et al. The value of (18)FDG-PET for the detection of infected hip prosthesis. Eur J Nucl Med Mol Imaging 2003;30:705–15.PubMed

25.

Kisielinski K, Cremerius U, Büll U, Hermanns B, Wirtz DC, Niethard FU. First experiences with fluorodeoxyglucose-positron-emission tomography (FDG-PET) in the evaluation of painful total knee and hip joint replacements. Z Orthop Ihre Grenzgeb 2003;141:153–9.PubMedCrossRef

26.

Chacko TK, Zhuang H, Stevenson K, Moussavian B, Alavi A. The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses. Nucl Med Commun 2002;23:851–5.PubMedCrossRef

27.

Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K. The use of [18 F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses. Nucl Med Commun 2002;23:645–53.PubMedCrossRef

28.

Van Acker F, Nuyts J, Maes A, Vanquickenborne B, Stuyck J, Bellemans J, et al. FDG-PET, 99mtc-HMPAO white blood cell SPET and bone scintigraphy in the evaluation of painful total knee arthroplasties. Eur J Nucl Med 2001;28:1496–504.PubMedCrossRef

29.

De Winter F, van de Wiele C, Vogelaers D, de Smet K, Verdonk R, Dierckx RA. Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections. J Bone Joint Surg Am 2001;83:651–60.PubMed

30.

Zhuang H, Duarte PS, Pourdehnad M, Maes A, Van Acker F, Shnier D, et al. The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med 2001;42:44–8.PubMed

31.

Love C, Pugliese PV, Afriyie MO, Tomas MB, Marwin SE, Palestro CJ. Utility of F-18 FDG imaging for diagnosing the infected joint replacement. Clin Positron Imaging 2000;3:159.PubMedCrossRef

32.

De Winter F, Van de Wiele C, Vandenberghe S, de Bondt P, de Clercq D, D'Asseler Y, et al. Coincidence camera FDG imaging for the diagnosis of chronic orthopedic infections: a feasibility study. J Comput Assist Tomogr 2001;25:184–9.PubMedCrossRef

33.

Zhuang H, Chacko TK, Hickeson M, Stevenson K, Feng Q, Ponzo F, et al. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty. Eur J Nucl Med Mol Imaging 2002;29:1328–33.PubMedCrossRef

34.

Goerres GW, Ziegler SI, Burger C, Berthold T, Von Schulthess GK, Buck A. Artifacts at PET and PET/CT caused by metallic hip prosthetic material. Radiology 2003;226:577–84.PubMedCrossRef

35.

Heiba SI, Luo J, Sadek S, Macalental E, Cacavio A, Rosen G, et al. Attenuation-correction induced artifact in F-18 FDG PET imaging following total knee replacement. Clin Positron Imaging 2000;3:237–9.PubMedCrossRef

36.

Becker W, Goldenberg DM, Wolf F. The use of monoclonal antibodies and antibody fragments in the imaging of infectious lesions. Semin Nucl Med 1994;24:142–53.PubMedCrossRef

37.

Skehan SJ, White JF, Evans JW, Parry-Jones DR, Solanki CK, Ballinger JR, et al. Mechanism of accumulation of 99mTc-sulesomab in inflammation. J Nucl Med 2003;44:11–8.PubMed

38.

Pakos EE, Trikalinos TA, Fotopoulos AD, Ioannidis JP. Prosthesis infection: diagnosis after total joint arthroplasty with antigranulocyte scintigraphy with 99mTc-labeled monoclonal antibodies—a meta-analysis. Radiology 2007;242:101–8.PubMedCrossRef

Title: FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis
Authors: Thomas C. Kwee
Robert M. Kwee
Abass Alavi
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2008
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-008-0887-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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