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Kahts M, Summers B, Gutta A, Pilloy W, Ebenhan T. Recently developed radiopharmaceuticals for bacterial infection imaging. EJNMMI Radiopharm Chem 2024; 9:49. [PMID: 38896373 PMCID: PMC11187059 DOI: 10.1186/s41181-024-00279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Infection remains a major cause of morbidity and mortality, regardless of advances in antimicrobial therapy and improved knowledge of microorganisms. With the major global threat posed by antimicrobial resistance, fast and accurate diagnosis of infections, and the reliable identification of intractable infection, are becoming more crucial for effective treatment and the application of antibiotic stewardship. Molecular imaging with the use of nuclear medicine allows early detection and localisation of infection and inflammatory processes, as well as accurate monitoring of treatment response. There has been a continuous search for more specific radiopharmaceuticals to be utilised for infection imaging. This review summarises the most prominent discoveries in specifically bacterial infection imaging agents over the last five years, since 2019. MAIN BODY Some promising new radiopharmaceuticals evaluated in patient studies are reported here, including radiolabelled bacterial siderophores like [68Ga]Ga-DFO-B, radiolabelled antimicrobial peptide/peptide fragments like [68Ga]Ga-NOTA-UBI29-41, and agents that target bacterial synthesis pathways (folic acid and peptidoglycan) like [11C]para-aminobenzoic acid and D-methyl-[11C]-methionine, with clinical trials underway for [18F]fluorodeoxy-sorbitol, as well as for 11C- and 18F-labelled trimethoprim. CONCLUSION It is evident that a great deal of effort has gone into the development of new radiopharmaceuticals for infection imaging over the last few years, with remarkable progress in preclinical investigations. However, translation to clinical trials, and eventually clinical Nuclear Medicine practice, is apparently slow. It is the authors' opinion that a more structured and harmonised preclinical setting and well-designed clinical investigations are the key to reliably evaluate the true potential of the newly proposed infection imaging agents.
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Affiliation(s)
- Maryke Kahts
- Pharmaceutical Sciences Department, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa.
| | - Beverley Summers
- Pharmaceutical Sciences Department, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa
| | - Aadil Gutta
- Nuclear Medicine Department, Dr George Mukhari Academic Hospital, Ga-Rankuwa, 0208, South Africa
- School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 0208, South Africa
| | - Wilfrid Pilloy
- Nuclear Medicine Department, Dr George Mukhari Academic Hospital, Ga-Rankuwa, 0208, South Africa
| | - Thomas Ebenhan
- Nuclear Medicine Department and Nuclear Medicine Research Infrastructure, University of Pretoria, Pretoria, 0001, South Africa
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Yano T, Tomioka R, Inagaki T, Akai R, Miyake K, Arai S, Tsukahara K. Role of follow-up gallium scintigraphy in the evaluation of malignant external otitis (skull base osteomyelitis): A case report. SAGE Open Med Case Rep 2024; 12:2050313X241253462. [PMID: 38764912 PMCID: PMC11100390 DOI: 10.1177/2050313x241253462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/18/2024] [Indexed: 05/21/2024] Open
Abstract
Malignant otitis externa (skull base osteomyelitis) can be fatal and long-term antibiotic therapy is recommended. Despite being potentially fatal, this infection causes minor changes in inflammatory biomarkers (white blood cell count and C-reactive protein levels) upon blood testing. Computed tomography and magnetic resonance imaging changes persist over a long period. Therefore, it is difficult to determine the optimal time for the discontinuation of antibiotics. We present a 77-year-old male whose medical history included type 2 diabetes mellitus who suffered from chronic otitis media with Pseudomonas aeruginosa infection. His condition did not improve with proper treatment, and imaging revealed malignant otitis media. Intravenous cefepime treatment was administered. Antibiotic treatment was de-escalated to oral levofloxacin treatment after Gallium-67 scintigraphy showed less accumulation after 6 weeks of Cefepime administration; accumulation almost disappeared after 1 year. In this report, we describe the usefulness of gallium scintigraphy in the evaluation of malignant otitis externa.
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Affiliation(s)
- Teruhisa Yano
- Department of Otorhinolaryngology, Head and Neck surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryota Tomioka
- Department of Otorhinolaryngology, Head and Neck surgery, Tokyo Medical University, Tokyo, Japan
| | - Taro Inagaki
- Department of Otorhinolaryngology, Head and Neck surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryo Akai
- Department of Otorhinolaryngology, Head and Neck surgery, Tokyo Medical University, Tokyo, Japan
| | - Keitaro Miyake
- Department of Otorhinolaryngology, Head and Neck surgery, Tokyo Medical University, Tokyo, Japan
| | - Sayaka Arai
- Department of Otorhinolaryngology, Head and Neck surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck surgery, Tokyo Medical University, Tokyo, Japan
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Mokoala KMG, Ndlovu H, Lawal I, Sathekge MM. PET/CT and SPECT/CT for Infection in Joints and Bones: An Overview and Future Directions. Semin Nucl Med 2024; 54:394-408. [PMID: 38016897 DOI: 10.1053/j.semnuclmed.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023]
Abstract
Infections of the bones and joints, if misdiagnosed, may result in serious morbidity and even mortality. A prompt diagnosis followed by appropriate management may reduce the socioeconomic impact of bone and joint infections. Morphologic imaging such as ultrasound and plain radiographs form the first line investigations, however, in early infections findings may be negative or nonspecific. Nuclear medicine imaging techniques play a complementary role to morphologic imaging in the diagnosis of bone and joint infections. The availability of hybrid systems (SPECT/CT, SPECT/MRI, PET/CT or PET/MRI) offers improved specificity with ability to assess the extent of infection. Bone scans are useful as a gatekeeper wherein negative scans rule out sepsis with a good accuracy, however positive scans are nondiagnostic and more specific tracers should be considered. These include the use of labeled white blood cells and antigranulocyte antibodies. Various qualitative and quantitative interpretation criteria have been suggested to improve the specificity of the scans. PET has better image resolution and 18F-FDG is the major tracer for PET imaging with applications in oncology and inflammatory/infective disorders. It has demonstrated improved sensitivity over the SPECT based tracers, however, still suffers from lack of specificity. 18F-FDG PET has been used to monitor therapy in bone and joint infections. Other less studied, noncommercialized SPECT and PET tracers such as 111In-Biotin, 99mTc-Ubiquicidin, 18F-Na-Fluoride, 18F-labeled white blood cells and 124I-Fialuridine to name a few have shown great promise, however, their role in various bone and joint infections has not been established. Hybrid imaging with PET or PET/MRI offers huge potential for improving diagnostics in infections of the joints and bones.
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Affiliation(s)
- Kgomotso M G Mokoala
- University of Pretoria, Pretoria, Gauteng, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, Gauteng, South Africa
| | - Honest Ndlovu
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, Gauteng, South Africa
| | - Ismaheel Lawal
- University of Pretoria, Pretoria, Gauteng, South Africa; Emory University, Atlanta, Georgia, United States
| | - Mike Machaba Sathekge
- University of Pretoria, Pretoria, Gauteng, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, Gauteng, South Africa.
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Russo A, Migliorini F, Giustra F, Bosco F, Massè A, Burastero G. Two-stage total joint replacement for hip or knee septic arthritis: post-traumatic etiology and difficult-to-treat infections predict poor outcomes. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05249-x. [PMID: 38430234 DOI: 10.1007/s00402-024-05249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Septic arthritis (SA) is a rare but significant clinical challenge in orthopedics that can impact patients' quality of life. This study aims to examine the clinical outcomes of patients undergoing two-stage total joint replacement (TJR) in hip and knee SA and analyze potential predictors of treatment failure. METHODS A retrospective analysis was conducted using data from a prospectively collected institutional arthroplasty registry from January 1st, 2012, to January 1st, 2019. Patients with hip or knee SA who underwent a two-stage TJR and had at least two years of follow-up were included. Demographic characteristics, surgical variables, and outcomes were collected and analyzed from clinical and surgical data. Statistical analysis was performed using IBM SPSS Statistics, with statistical significance at p < 0.05. RESULTS One hundred and fourteen patients (61 with hip SA, 53 with knee SA) were included in the study. The mean follow-up was 72.8 months. Postoperatively, both clinical and functional outcomes significantly improved, as indicated by the Hip Society Score (HHS) and Knee Society Score (KSS). The overall success rate of the two-stage protocol was 89.5%. Complications that did not require revision occurred in 21% of cases. The most identified pathogen was methicillin-sensitive Staphylococcus aureus (MSSA). Difficult-to-treat (DTT) infections and post-traumatic etiology were identified as predictors of treatment failure in patients undergoing two-stage TJR for hip and knee SA. CONCLUSIONS Two-stage TJR in hip and knee SA demonstrated favorable clinical outcomes at mid-term follow-up. The procedure significantly improved functional scores and achieved a high success rate, while DTT infections and post-traumatic etiology were associated with a higher risk of treatment failure.
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Affiliation(s)
- Antonio Russo
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29 10126, Turin, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, 39100, Italy
| | - Fortunato Giustra
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
- Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, Palermo, Italy.
| | - Alessandro Massè
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29 10126, Turin, Italy
| | - Giorgio Burastero
- IRCCS Ospedale Galeazzi-Sant'Ambrogio, Via Cristina Belgioioso 173, Milan, 20157, Italy
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Gao H, Li G, Fu C, Ren J, Kang F, Luo W, Yin Q, Zhou C, Li B, Lu S, Wang H, Zhang Y, Zhang Y. Comparison of diagnostic efficacy between 99mTc-methylene diphosphate SPECT/CT and MRI for bone and joint infections: a multicenter retrospective analysis. Front Endocrinol (Lausanne) 2024; 15:1359655. [PMID: 38487344 PMCID: PMC10937577 DOI: 10.3389/fendo.2024.1359655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/18/2024] [Indexed: 03/17/2024] Open
Abstract
Objective There is currently no non-invasive examination that can fully determine the diagnosis of osteomyelitis. SPECT/CT tomographic fusion imaging can provide both local metabolic activity and anatomical information to determine the condition and location. This study evaluates the diagnostic efficacy of 99mTc-MDP SPECT/CT in bone infections, compared to MRI. Methods In this multicenter retrospective study, 363 patients with suspected bone and joint infections or osteomyelitis were included. Participants underwent 99mTc-MDP SPECT/CT and/or MRI examinations, supplemented by pathogenic bacterial cultures and histopathological analysis. Results Only SPECT/CT was tested in 169 patients, and only MRI was used in 116. 78 people have implemented both inspections and have detailed information. The diagnostic sensitivity and specificity of SPECT/CT for infection were 96% and 92% respectively, with an accuracy of 96%. For MRI, these figures were 88%, 84%, and 87% respectively. Conclusion This represents the largest global study to date evaluating osteomyelitis and bone infection diagnosis using 99mTc-MDP SPECT/CT tomographic fusion imaging. The findings indicate that 99mTc-MDP SPECT/CT fusion imaging offers superior diagnostic accuracy compared to MRI. This is particularly evident in cases involving metallic implants and chronic infections. 99mTc-MDP SPECT/CT fusion imaging emerges as a highly suitable non-invasive diagnostic modality, facilitating enhanced clinical follow-up and treatment.
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Affiliation(s)
- Hao Gao
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Guoquan Li
- Department of Nuclear Medicine, First Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Congxiao Fu
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Jun Ren
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Fei Kang
- Department of Nuclear Medicine, First Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Wen Luo
- Department of Ultrasound, First Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Qian Yin
- Department of Radiology, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Cheng Zhou
- Department of Nuclear Medicine, First Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Bo Li
- Department of Radiology, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Shuaikun Lu
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Hu Wang
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yong Zhang
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Yunfei Zhang
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi’an, Shaanxi, China
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PET-Computed Tomography in Bone and Joint Infections. PET Clin 2023; 18:49-69. [DOI: 10.1016/j.cpet.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Aleksyniene R, Iyer V, Bertelsen HC, Nilsson MF, Khalid V, Schønheyder HC, Larsen LH, Nielsen PT, Kappel A, Thomsen TR, Lorenzen J, Ørsted I, Simonsen O, Jordal PL, Rasmussen S. The Role of Nuclear Medicine Imaging with 18F-FDG PET/CT, Combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT in the Evaluation of Patients with Chronic Problems after TKA or THA in a Prospective Study. Diagnostics (Basel) 2022; 12:diagnostics12030681. [PMID: 35328234 PMCID: PMC8947521 DOI: 10.3390/diagnostics12030681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The aim of this prospective study was to assess the diagnostic value of nuclear imaging with 18F-FDG PET/CT (FDG PET/CT), combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT (dual-isotope WBC/bone marrow scan) for patients with chronic problems related to knee or hip prostheses (TKA or THA) scheduled by a structured multidisciplinary algorithm. Materials and Methods: Fifty-five patients underwent imaging with 99mTc–HDP SPECT/CT (bone scan), dual-isotope WBC/bone marrow scan, and FDG PET/CT. The final diagnosis of prosthetic joint infection (PJI) and/or loosening was based on the intraoperative findings and microbiological culture results and the clinical follow-up. Results: The diagnostic performance of dual-isotope WBC/bone marrow SPECT/CT for PJI showed a sensitivity of 100% (CI 0.74–1.00), a specificity of 97% (CI 0.82–1.00), and an accuracy of 98% (CI 0.88–1.00); for PET/CT, the sensitivity, specificity, and accuracy were 100% (CI 0.74–1.00), 71% (CI 0.56–0.90), and 79% (CI 0.68–0.93), respectively. Conclusions: In a standardized prospectively scheduled patient group, the results showed highly specific performance of combined dual-isotope WBC/bone marrow SPECT/CT in confirming chronic PJI. FDG PET/CT has an appropriate accuracy, but the utility of its use in the clinical diagnostic algorithm of suspected PJI needs further evidence.
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Affiliation(s)
- Ramune Aleksyniene
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
- Correspondence: ; Tel.: +45-41416038
| | - Victor Iyer
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
- Department of Radiology and Molecular Medicine, University Hospital Uppsala, 75237 Uppsala, Sweden
| | - Henrik Christian Bertelsen
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
| | - Majbritt Frost Nilsson
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
| | - Vesal Khalid
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark; (V.K.); (S.R.)
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.C.S.); (L.H.L.)
| | - Lone Heimann Larsen
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.C.S.); (L.H.L.)
| | - Poul Torben Nielsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Andreas Kappel
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Trine Rolighed Thomsen
- Center for Microbial Communities, Aalborg University, 9220 Aalborg, Denmark;
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Jan Lorenzen
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Iben Ørsted
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Ole Simonsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Peter Lüttge Jordal
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark; (V.K.); (S.R.)
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark
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Noriega-Álvarez E, Pena Pardo FJ, Jiménez Londoño GA, García Vicente A. Gamma camera imaging of musculoskeletal infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Basilio-Razon PIE, Wong E. A Pain in the Foot: Delayed Diagnosis of Primary Septic Arthritis of Naviculocuneiform and Second/Third Tarsometatarsal Joints. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933233. [PMID: 34711795 PMCID: PMC8564783 DOI: 10.12659/ajcr.933233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 65-year-old
Final Diagnosis: Septic arthritis of midfoot
Symptoms: Foot pain
Medication: —
Clinical Procedure: Debridement • drainage
Specialty: Family Medicine • General and Internal Medicine • Orthopedics • Emergency Medicine
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Affiliation(s)
| | - Evelyn Wong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Tagiling N, Mohd-Rohani MF, Wan-Sohaimi WF, Faisham WI, Nawi NM. Combined Techniques of Non-invasive 99mTc-Besilesomab/ 99mTc-Sulfur Colloid with Hybrid SPECT/CT Imaging in Characterising Cellulitis from Symptomatic Perimegaprosthetic Infection: A Case Report. Malays Orthop J 2021; 14:188-193. [PMID: 33403085 PMCID: PMC7752015 DOI: 10.5704/moj.2011.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Megaprosthesis is used to restore the form and function of massive skeletal defects, but it is accompanied by risks of failure, mainly due to perimegaprosthetic infection (PMI). In practice, the diagnosis of infected megaprosthesis among patients with a high index of clinical suspicion, elevated serological markers, and multiple negative or inconclusive imaging can be very challenging and poses a diagnostic conundrum to many orthopaedic surgeons. We present the case of a symptomatic 26-year-old female with large B-cell lymphoma who developed cellulitis with suspected complication of PMI 15 months post-implantation. The combination of advanced nuclear medicine imaging strategies, i.e., 99mTc-besilesomab/99mTc-sulfur colloid scintigraphy with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanning helps to characterise and delineate both infections. Invasive procedures such as joint aspiration and biopsy were avoided, and the patient was successfully treated with antibiotics. Hence, we report a case where advanced imaging modalities were decisive in the investigation of PMI.
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Affiliation(s)
- N Tagiling
- Department of Nuclear Medicine, Radiotherapy and Oncology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M F Mohd-Rohani
- Nuclear Medicine Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - W F Wan-Sohaimi
- Department of Nuclear Medicine, Radiotherapy and Oncology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W I Faisham
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - N M Nawi
- Department of Nuclear Medicine, Radiotherapy and Oncology, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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