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European Journal of Nuclear Medicine and Molecular Imaging

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01-03-2014 | Original Article

FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection

Authors: Sabire Yılmaz Aksoy, Sertac Asa, Meftune Ozhan, Meltem Ocak, M. Sait Sager, Melih Engin Erkan, Metin Halac, Levent Kabasakal, Kerim Sönmezoglu, Bedii Kanmaz

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2014

Abstract

Purpose

The demand for arthroplasty is rapidly growing as a result of the ageing of the population. Although complications such as heterotrophic ossification, fracture and dislocation are relatively rare, differentiating aseptic loosening, the most common complication of arthroplasty from infection, is a major challenge for clinicians. Radionuclide imaging is currently the imaging modality of choice since it is not affected by orthopaedic hardware. Whereas FDG PET/CT imaging has been widely used in periprosthetic infection, it cannot discriminate aseptic from septic inflammation. In this study we aimed to evaluate the role of FDG PET/CT and FDG-labelled leucocyte PET/CT in the diagnosis of periprosthetic infection.

Methods

Of 54 patients with painful joint arthroplasty who were imaged by FDG PET/CT for diagnosis of periprosthetic infection examined, 46 (36 women, 10 men; mean age 61.04 ± 12.2 years, range 32 – 89 years) with 54 painful joint prostheses (19 hip, 35 knee) with grade 2 (above liver uptake) FDG accumulation on FDG PET/CT were included in the study and these 46 patients also underwent FDG-labelled leucocyte PET/CT. Final diagnoses were made by histopathological-microbiological culture or clinical follow-up.

Results

The final diagnosis showed infection in 15 (28 %) and aseptic loosening in 39 (72 %) of the 54 prostheses. FDG PET/CT was found to have a positive predictive value of 28 % (15/54). Since patients with no FDG uptake on FDG PET/CT were excluded from the study, the sensitivity, specificity, negative predictive value and accuracy could not be calculated. The sensitivity, specificity, and positive and negative predictive values of FDG-labelled leucocyte PET/CT were 93.3 % (14/15), 97.4 % (38/39), 93.3 % and 97.4 %, respectively.

Conclusion

Since FDG is not specific to infection, the specificity of FDG PET/CT was very low. FDG-labelled leucocyte PET/CT with its high specificity may be a useful method and better than labelled leucocyte scintigraphy in periprosthetic infection imaging.

National Institutes of Health. Deep infections of total joint replacement. PA number PA-00-014. NIH Bethesda; 1999.

Mulamba L, Ferrant A, Leners N, de Nayer P, Rombouts JJ, Vincent A. Indium-111 leucocyte scanning in the evaluation of painful hip arthroplasty. Acta Orthop Scand. 1983;54(5):695–7.PubMedCrossRef

Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med. 1990;31(12):1950–5.PubMed

Palestro CJ, Swyer AJ, Kim CK, Goldsmith SJ. Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging. Radiology. 1991;179(3):645–8.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.PubMedCrossRef

El-Maghraby TA, Moustafa HM, Pauwels EK. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. Q J Nucl Med Mol Imaging. 2006;50:167–92.PubMed

Vinjamuri S, Hall AV, Solanki KK, Bomanji J, Siraj Q, O’Shaughnessy E, et al. Comparison of 99mTc infecton imaging with radiolabelled white-cell imaging in the evaluation of bacterial infection. Lancet. 1996;347(8996):233–5.PubMedCrossRef

Sonmezoglu K, Sonmezoglu M, Halac M, Akgün I, Türkmen C, Onsel C, et al. Usefulness of 99mTc-ciprofloxacin (Infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy. J Nucl Med. 2001;42(4):567–74.PubMed

Sarda L, Crémieux AC, Lebellec Y, Meulemans A, Lebtahi R, Hayem G, et al. Inability of 99mTc-ciprofloxacin scintigraphy to discriminate between septic and sterile osteoarticular diseases. J Nucl Med. 2003;44(6):920–6.PubMed

10.

Dumarey N, Blocklet D, Appelboom T, Tant L, Schoutens A. Infecton is not specific for bacterial osteo-articular infective pathology. Eur J Nucl Med Mol Imaging. 2002;29(4):530–5.PubMedCrossRef

11.

van Eerd JE, Oyen WJ, Harris TD, Rennen HJ, Edwards DS, Liu S, et al. A bivalent leukotriene B(4) antagonist for scintigraphic imaging of infectious foci. J Nucl Med. 2003;44(7):1087–91.PubMed

12.

Fischman AJ, Babich JW, Strauss HW. A ticket to ride: peptide radiopharmaceuticals. J Nucl Med. 1993;34(12):2253–63.PubMed

13.

De Winter F, Vogelaers D, Gemmel F, Dierckx RA. Promising role of 18-F-fluoro-D-deoxyglucose positron emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis. 2002;21(4):247–57.PubMedCrossRef

14.

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(6):615–24.PubMedCrossRef

15.

Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–80.PubMed

16.

Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med. 1996;26:308–14.PubMedCrossRef

17.

Osman S, Danpure HJ. The use of 2-[18F]fluoro-2-deoxy-D-glucose as a potential in vitro agent for labelling human granulocytes for clinical studies by positron emission tomography. Int J Rad Appl Instrum B. 1992;19(2):183–90.PubMedCrossRef

18.

Rini JN, Bhargava KK, Tronco GG, Singer C, Caprioli R, Marwin SE, et al. PET with FDG-labeled leukocytes versus scintigraphy with 111In-oxine-labeled leukocytes for detection of infection. Radiology. 2006;238(3):978–87.PubMedCrossRef

19.

Forstrom LA, Mullan BP, Hung JC, Lowe VJ, Thorson LM. 18F-FDG labelling of human leukocytes. Nucl Med Commun. 2000;21(7):691–4.PubMedCrossRef

20.

Lafont P, Morelec I, Fraysse M, Got P, Houzard C, Confavreux A, et al. 18F-FDG labelled leukocytes in vitro functional tests: viability, chemotaxis and phagocytosis assays. Open Nucl Med J. 2011;3:25–9.CrossRef

21.

van der Bruggen W, Bleeker-Rovers CP, Boerman OC, Gotthardt M, Oyen WJ. PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review. Semin Nucl Med. 2010;40(1):3–15.PubMedCrossRef

22.

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(10):1328–33.PubMedCrossRef

23.

Love C, Marwin SE, Tomas MB, Krauss ES, Tronco GG, Bhargava KK, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection fluorine-18 FDG and indium-111-labeled leukocyte/technetium-99m-sulfur colloid marrow imaging. J Nucl Med. 2004;45:1864–71.PubMed

24.

Yao WJ, Hoh CK, Hawkins RA, Glaspy JA, Weil JA, Lee SJ, et al. Quantitative PET imaging of bone marrow glucose metabolic response to hematopoietic cytokines. J Nucl Med. 1995;36(5):794–9.PubMed

25.

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

26.

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

27.

Pio BS, Byrne FR, Aranda R, Boulay G, Spicher K, Song MH, et al. Noninvasive quantification of bowel inflammation through positron emission tomography imaging of 2-deoxy-2-[18F]fluoro-D-glucose-labeled white blood cells. Mol Imaging Biol. 2003;5(4):271–7.PubMedCrossRef

28.

Dumarey N, Egrise D, Blocklet D, Stallenberg B, Remmelink M, del Marmol V, et al. Imaging infection with 18F-FDG-labeled leukocyte PET/CT: initial experience in 21 patients. J Nucl Med. 2006;47:625–32.PubMed

29.

Forstrom LA, Dunn WL, Mullan BP, Hung JC, Lowe VJ, Thorson LM. Biodistribution and dosimetry of [18F]fluorodeoxyglucose labelled leukocytes in normal human subjects. Nucl Med Commun. 2002;23:721–5.PubMedCrossRef

30.

Pellegrino D, Bonab AA, Dragotakes SC, Pitman JT, Mariani G, Carter EA. Inflammation and infection: imaging properties of 18F-FDG-labeled white blood cells versus 18F-FDG. J Nucl Med. 2005;46:1522–30.PubMed

31.

Yılmaz S, Ocak M, Asa S, Aliyev A, Ozhan M, Halac M, et al. The different distribution patterns of FDG and FDG-labelled WBC in inflammatory and infectious lesions. Eur J Nucl Med Mol Imaging. 2012;39(10):1660–1.PubMedCrossRef

Title: FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection
Authors: Sabire Yılmaz Aksoy
Sertac Asa
Meftune Ozhan
Meltem Ocak
M. Sait Sager
Melih Engin Erkan
Metin Halac
Levent Kabasakal
Kerim Sönmezoglu
Bedii Kanmaz
Publication date: 01-03-2014
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2597-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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