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European Journal of Nuclear Medicine and Molecular Imaging

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01-08-2010 | Original Article

Detection of low-grade prosthetic joint infections using ^99mTc-antigranulocyte SPECT/CT: initial clinical results

Authors: Vera Graute, Markus Feist, Sebastian Lehner, Alexander Haug, Peter Ernst Müller, Peter Bartenstein, Marcus Hacker

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 9/2010

Abstract

Purpose

Low-grade joint infections are characterized by infiltration of granulocytes, which mediate aspects of inflammatory changes. We evaluated retrospectively the contribution of SPECT/CT as an addition to planar scintigraphy with ^99mTc-labelled antigranulocyte antibodies for diagnosing and localizing low-grade joint infections.

Methods

Planar scintigraphy using ^99mTc-labelled antigranulocyte BW 250/183 antibodies was performed in 31 patients with suspected joint infections at 5 min, 5 h and 24 h after injection, with additional SPECT/CT performed 6 h after injection. With reference to gold standard clinical data, we assessed the diagnostic sensitivity of scintigraphy alone and in conjunction with SPECT/CT.

Results

Joint infections were diagnosed clinically in 9 of the 31 patients (1 hip and 8 knee prostheses). Planar scintigraphy revealed 6 true-positives, 13 true-negatives, 9 false-positives and 3 false-negative results, indicating sensitivity, specificity, positive and negative predictive values of, respectively, 0.66, 0.60, 0.4 and 0.81. With the addition of SPECT images, corresponding sensitivity, specificity, positive and negative predictive values increased to 0.89, 0.45, 0.40 and 0.91. Implementation of fused SPECT/CT led to a further increase to 0.89, 0.73, 0.57 and 0.94.

Conclusion

Relative to planar scintigraphy, SPECT with and without CT substantially improved the utility of imaging with ^99mTc-labelled antigranulocyte antibodies for diagnosis and localization of suspected joint infections. Optimal accuracy was obtained through image fusion, which permitted anatomical allocation of foci of pathological tracer accumulation as well as providing information on the extent of the infection. This imaging method seems suited for selection of patients requiring surgical therapy.

Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med 2009;39:66–78. doi:S0001-2998(08)00104-9 [pii] 10.1053/j.semnuclmed.2008.08.007.CrossRefPubMed

Boubaker A, Delaloye AB, Blanc CH, Dutoit M, Leyvraz PF, Delaloye B. Immunoscintigraphy with antigranulocyte monoclonal antibodies for the diagnosis of septic loosening of hip prostheses. Eur J Nucl Med 1995;22:139–47.CrossRefPubMed

Fitzgerald RH Jr, Nolan DR, Ilstrup DM, Van Scoy RE, Washington JA 2nd, Coventry MB. Deep wound sepsis following total hip arthroplasty. J Bone Joint Surg Am 1977;59:847–55.PubMed

Ivanćević V, Perka C, Hasart O, Sandrock D, Munz DL. Imaging of low-grade bone infection with a technetium-99m labelled monoclonal anti-NCA-90 Fab′ fragment in patients with previous joint surgery. Eur J Nucl Med Mol Imaging 2002;29:547–51. doi:10.1007/s00259-001-0744-7.CrossRefPubMed

Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am 1999;81:672–83.PubMed

Reinartz P. FDG-PET in patients with painful hip and knee arthroplasty: technical breakthrough or just more of the same. Q J Nucl Med Mol Imaging 2009;53:41–50.PubMed

Schillaci O, Danieli R, Manni C, Simonetti G. Is SPECT/CT with a hybrid camera useful to improve scintigraphic imaging interpretation? Nucl Med Commun 2004;25:705–10. doi:00006231-200407000-00012 [pii].CrossRefPubMed

Iyengar KP, Vinjamuri S. Role of 99mTc Sulesomab in the diagnosis of prosthetic joint infections. Nucl Med Commun 2005;26:489–96. doi:00006231-200506000-00003 [pii].CrossRefPubMed

Kaisidis A, Megas P, Apostolopoulos D, Spiridonidis T, Koumoundourou D, Zouboulis P, et al. Diagnosis of septic loosening of hip prosthesis with LeukoScan. SPECT scan with 99mTc-labeled monoclonal antibodies. Orthopade 2005;34:462–9. German. doi:10.1007/s00132-005-0777-x.CrossRefPubMed

10.

von Rothenburg T, Schoellhammer M, Schaffstein J, Koester O, Schmid G. Imaging of infected total arthroplasty with Tc-99m-labeled antigranulocyte antibody Fab′fragments. Clin Nucl Med 2004;29:548–51. doi:00003072-200409000-00006 [pii].CrossRef

11.

Kordelle J, Klett R, Stahl U, Hossain H, Schleicher I, Haas H. Infection diagnosis after knee-TEP-implantation. Z Orthop Ihre Grenzgeb 2004;142:337–43. German. doi:10.1055/s-2004-818772.CrossRefPubMed

12.

Rubello D, Casara D, Maran A, Avogaro A, Tiengo A, Muzzio PC. Role of anti-granulocyte Fab′ fragment antibody scintigraphy (LeukoScan) in evaluating bone infection: acquisition protocol, interpretation criteria and clinical results. Nucl Med Commun 2004;25:39–47. doi:00006231-200401000-00006 [pii].CrossRefPubMed

13.

Vicente AG, Almoguera M, Alonso JC, Heffernan AJ, Gomez A, Contreras PI, et al. Diagnosis of orthopedic infection in clinical practice using Tc-99m sulesomab (antigranulocyte monoclonal antibody fragment Fab′2). Clin Nucl Med 2004;29:781–5. doi:00003072-200412000-00001 [pii].CrossRefPubMed

14.

Gratz S, Schipper ML, Dorner J, Höffken H, Becker W, Kaiser JW, et al. LeukoScan for imaging infection in different clinical settings: a retrospective evaluation and extended review of the literature. Clin Nucl Med 2003;28:267–76. doi:10.1097/01.RLU.0000057613.86093.73.CrossRefPubMed

15.

Ryan PJ. Leukoscan for orthopaedic imaging in clinical practice. Nucl Med Commun 2002;23:707–14.CrossRefPubMed

16.

Klett R, Khalisi A, Haas H, Puille M, Steiner D, Stürz H, et al. Staged diagnosis of septic hip endoprosthesis loosening with laboratory parameters and antigranulocyte scintigraphy. Z Orthop Ihre Grenzgeb 2001;139:415–9. German.CrossRefPubMed

17.

Devillers A, Garin E, Polard JL, Poirier JY, Arvieux C, Girault S, et al. Comparison of Tc-99m-labelled antileukocyte fragment Fab′ and Tc-99m-HMPAO leukocyte scintigraphy in the diagnosis of bone and joint infections: a prospective study. Nucl Med Commun 2000;21:747–53.CrossRefPubMed

18.

Sciuk J, Puskás C, Greitemann B, Schober O. White blood cell scintigraphy with monoclonal antibodies in the study of the infected endoprosthesis. Eur J Nucl Med 1992;19:497–502.CrossRefPubMed

19.

Wolf G, Aigner RM, Schwarz T, Lorbach MP. Localization and diagnosis of septic endoprosthesis infection by using 99mTc-HMPAO labelled leucocytes. Nucl Med Commun 2003;24:23–8. doi:10.1097/01.mnm.0000051628.18733.cc.CrossRefPubMed

20.

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. doi:2421052011 [pii] 10.1148/radiol.2421052011.CrossRefPubMed

21.

Weon YC, Yang SO, Choi YY, Shin JW, Ryu JS, Shin MJ, et al. Use of Tc-99m HMPAO leukocyte scans to evaluate bone infection: incremental value of additional SPECT images. Clin Nucl Med 2000;25:519–26.CrossRefPubMed

22.

Townsend DW, Cherry SR. Combining anatomy and function: the path to true image fusion. Eur Radiol 2001;11:1968–74. doi:10.1007/s003300101007.CrossRefPubMed

23.

Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. J Nucl Med 2006;47:1908–13. doi:47/12/1908 [pii].PubMed

24.

Horger M, Eschmann SM, Pfannenberg C, Storek D, Dammann F, Vonthein R, et al. The value of SPET/CT in chronic osteomyelitis. Eur J Nucl Med Mol Imaging 2003;30:1665–73.CrossRefPubMed

25.

Patel R, Osmon DR, Hanssen AD. The diagnosis of prosthetic joint infection: current techniques and emerging technologies. Clin Orthop Relat Res 2005;437:55–8.CrossRefPubMed

26.

Sadiq S, Wootton JR, Morris CA, Northmore-Ball MD. Application of core biopsy in revision arthroplasty for deep infection. J Arthroplasty 2005;20:196–201.CrossRefPubMed

27.

Savarino L, Baldini N, Tarabusi C, Pellacani A, Giunti A. Diagnosis of infection after total hip replacement. J Biomed Mater Res B Appl Biomater 2004;70:139–45. doi:10.1002/jbm.b.30030.CrossRefPubMed

28.

Fitzgerald RH Jr. Total hip arthroplasty sepsis. Prevention and diagnosis. Orthop Clin North Am 1992;23:259–64.PubMed

29.

Garvin KL, Hanssen AD. Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am 1995;77:1576–88.PubMed

30.

Mirra JM, Amstutz HC, Matos M, Gold R. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res 1976;117:221–40.PubMed

31.

Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 1998;36:2932–9.PubMed

Title: Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results
Authors: Vera Graute
Markus Feist
Sebastian Lehner
Alexander Haug
Peter Ernst Müller
Peter Bartenstein
Marcus Hacker
Publication date: 01-08-2010
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 9/2010
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-010-1431-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Detection of low-grade prosthetic joint infections using ^99mTc-antigranulocyte SPECT/CT: initial clinical results

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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