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Wang XQ, Ren XQ, Qin DA. Thigh pain after total hip arthroplasty. Int J Surg 2023; 109:3236-3237. [PMID: 37410027 PMCID: PMC10583958 DOI: 10.1097/js9.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Xiao-qiang Wang
- Department of Medical Imaging Center, Shanxi Provincial People’s Hospital
| | - Xiao-qiang Ren
- Department of Medical Information Center, Shanxi Provincial People’s Hospital
| | - De-an Qin
- Department of Orthopedics, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
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2
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Richter A, Stukenborg-Colsman C, Plaass C. SPECT/CT of Total Ankle Arthroplasty. Foot Ankle Clin 2023; 28:493-507. [PMID: 37536815 DOI: 10.1016/j.fcl.2023.04.001] [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] [Indexed: 08/05/2023]
Abstract
Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.
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Affiliation(s)
- Alena Richter
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany
| | - Christina Stukenborg-Colsman
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany
| | - Christian Plaass
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany.
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3
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Hu S, Lu R, Zhu Y, Zhu W, Jiang H, Bi S. Application of Medical Image Navigation Technology in Minimally Invasive Puncture Robot. SENSORS (BASEL, SWITZERLAND) 2023; 23:7196. [PMID: 37631733 PMCID: PMC10459274 DOI: 10.3390/s23167196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Microneedle puncture is a standard minimally invasive treatment and surgical method, which is widely used in extracting blood, tissues, and their secretions for pathological examination, needle-puncture-directed drug therapy, local anaesthesia, microwave ablation needle therapy, radiotherapy, and other procedures. The use of robots for microneedle puncture has become a worldwide research hotspot, and medical imaging navigation technology plays an essential role in preoperative robotic puncture path planning, intraoperative assisted puncture, and surgical efficacy detection. This paper introduces medical imaging technology and minimally invasive puncture robots, reviews the current status of research on the application of medical imaging navigation technology in minimally invasive puncture robots, and points out its future development trends and challenges.
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Affiliation(s)
| | - Rongjian Lu
- School of Mechanical and Electronic Engineering, Nanjing Forestry University, Nanjing 210037, China; (S.H.)
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Woisetschläger M, Booij R, Tesselaar E, Oei EHG, Schilcher J. Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT. Eur Radiol Exp 2023; 7:19. [PMID: 37121937 PMCID: PMC10149426 DOI: 10.1186/s41747-023-00335-y] [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: 01/06/2023] [Accepted: 02/28/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Successful osseointegration of joint replacement implants is required for long-term implant survival. Accurate assessment of osseointegration could enable clinical discrimination of failed implants from other sources of pain avoiding unnecessary surgeries. Photon-counting detector computed tomography (PCD-CT) provides improvements in image resolution compared to conventional energy-integrating detector CT (EID-CT), possibly allowing better visualization of bone-implant-interfaces and osseointegration. The aim of this study was to assess the quality of visualization of bone-implant-interfaces and osseointegration in acetabular cup implants, using PCD-CT compared with EID-CT. METHODS Two acetabular implants (one cemented, one uncemented) retrieved during revision surgery were scanned using PCD-CT and EID-CT at equal radiation dose. Images were reconstructed using different reconstruction kernels and iterative strengths. Delineation of the bone-implant and bone-cement-interface as an indicator of osseointegration was scored subjectively for image quality by four radiologists on a Likert scale and assessed quantitatively. RESULTS Delineation of bone-implant and bone-cement-interfaces was better with PCD-CT compared with EID-CT (p ≤ 0.030). The highest ratings were given for PCD-CT at sharper kernels for the cemented cup (PCD-CT, median 5, interquartile range 4.25-5.00 versus EID-CT, 3, 2.00-3.75, p < 0.001) and the uncemented cup (5, 4.00-5.00 versus 2, 2-2, respectively, p < 0.001). The bone-implant-interface was 35-42% sharper and the bone-cement-interface was 28-43% sharper with PCD-CT compared with EID-CT, depending on the reconstruction kernel. CONCLUSIONS PCD-CT might enable a more accurate assessment of osseointegration of orthopedic joint replacement implants. KEY POINTS • The bone-implant interface ex vivo showed superior visualization using photon-counting detector computed tomography (PCD-CT) compared to energy-integrating detector computed tomography. • Harder reconstruction kernels in PCD-CT provide sharper images with lower noise levels. • These improvements in imaging might make it possible to visualize osseointegration in vivo.
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Affiliation(s)
- Mischa Woisetschläger
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Ronald Booij
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erik Tesselaar
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Medical Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jörg Schilcher
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Orthopedics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden
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5
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Single photon emission computed tomography/computed tomography imaging of gouty arthritis: A new voice. J Transl Int Med 2023. [DOI: 10.2478/jtim-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Abstract
Gouty arthritis, often referred to simply as gout, is a disorder of purine metabolism characterized by the deposition of monosodium urate monohydrate (MSU) crystals in multiple systems and organs, especially in joints and their surrounding soft tissue. Gout is a treatable chronic disease, and the main strategy for effective management is to reverse the deposition of MSU crystals by uric acid reduction, and to prevent gout attacks, tophi deposition and complications, and thereby improve the quality of life. However, the frequent association of gout with other conditions such as hypertension, obesity, cardiovascular disease, diabetes, dyslipidemia, chronic kidney disease (CKD) and kidney stones can complicate the treatment of gout and lead to premature death. Here, we review the use of medical imaging techniques for studying gouty arthritis with special interest in the potential role of single photon emission computed tomography (SPECT)/computed tomography (CT) in the clinical management of gout and complications (e.g., chronic kidney disease and cardiovascular disease).
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Review of the role of bone-SPECT/CT in tarsal coalitions. Nucl Med Commun 2023; 44:115-130. [PMID: 36630216 DOI: 10.1097/mnm.0000000000001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Tarsal coalition (TC) is a congenital abnormal connection (fibrous, cartilaginous, or osseous) between two or more bones in the hind and midfoot, mostly consisting of calcaneonavicular or talocalcaneal coalition, and is often asymptomatic. However, TCs may result in foot motion limitation and pain with or without flatfoot (pes planus), arising in adolescents and young adults. Appropriate imaging is needed to pinpoint foot pain in the (suspected) TC, starting with plain radiographs. Still, normal radiographs do not exclude TCs. Computed tomography (CT) and MRI are frequently used advanced imaging techniques. CT alone has known limited sensitivity in cartilaginous and fibrous TCs and correlation between CT abnormalities and pain may be challenging, as solely anatomical changes in TCs are often asymptomatic. MRI can depict soft tissue abnormalities in TC with high accuracy. Nonetheless, after the implantation of metallic osteosynthesis material, MRI is often limited due to image distortion, signal loss, and misregistration. Bone scintigraphy with [99mTc]Tc-diphosphonate single photon emission computed tomography/CT (bone-SPECT/CT) is a known sensitive tool to detect osteoblastic bone pathology. However, the literature concerning bone-SPECT/CT in TC patients is limited. This article reviews bone-SPECT/CT patterns in TCs, how it complements other imaging techniques and their relation to clinical complaints. Bone-SPECT/CT excels in accurate bone pathology characterization in TC, confidently excluding synchronous lesions elsewhere, and offering optimal insight into osseous structures and 3D-localization of bone metabolism for surgery planning. Furthermore, even with implanted osteosynthesis material, bone-SPECT/CT can pinpoint the culprit pain generator, where MRI is either contra-indicated or considerably hampered.
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Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy. J Clin Med 2022; 11:jcm11154416. [PMID: 35956033 PMCID: PMC9369831 DOI: 10.3390/jcm11154416] [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] [Received: 05/22/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Abstract
Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.
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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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van den Wyngaert T, de Schepper S, Elvas F, Seyedinia SS, Beheshti M. Positron emission tomography-magnetic resonance imaging as a research tool in musculoskeletal conditions. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:15-30. [PMID: 35005878 DOI: 10.23736/s1824-4785.22.03434-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Compared to positron emission tomography/computed tomography (PET/CT), the uptake of PET- magnetic resonance imaging (MRI) has been slow, even more so in clinical practice compared to the (pre-)clinical research setting. However, for applications in musculoskeletal (MSK) research, the combination of PET and MRI into a single modality offers attractive advantages over other imaging modalities. Most importantly, MRI has exquisite soft-tissue detail without the use of contrast agents or ionizing radiation, superior bone marrow visualization, and an extensive spectrum of distinct multiparametric assessment methods. In the preclinical setting, the introduction of PET inserts for small-animal MRI machines has proven to be a successful concept in bringing this technology to the lab. Initial hurdles in quantification have been mainly overcome in this setting. In parallel, a promising range of radiochemistry techniques has been developed to create multimodality probes that offer the possibility of simultaneously querying different metabolic pathways. Not only will these applications help in elucidating disease mechanisms, but they can also facilitate drug development. The clinical applications of PET/MRI in MSK are still limited, but encouraging initial results with novel radiotracers suggest a high potential for use in various MSK conditions, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and inflammation and infection. Further innovations will be required to bring down the cost of PET/MRI to justify a broader clinical implementation, and remaining issues with quality control and standardization also need to be addressed. Nevertheless, PET/MRI is a powerful platform for MSK research with distinct qualities that are not offered by other techniques.
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Affiliation(s)
- Tim van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium -
- Faculty of Medicine and Health Sciences (MICA), University of Antwerp, Wilrijk, Belgium -
- Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium -
| | - Stijn de Schepper
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences (MICA), University of Antwerp, Wilrijk, Belgium
| | - Filipe Elvas
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences (MICA), University of Antwerp, Wilrijk, Belgium
| | - Seyedeh S Seyedinia
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Gamma camera imaging (bone scan) in orthopedics: Foot, ankle, knees, and hip. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Braun M, Cachovan M, Kaul F, Caobelli F, Bäumer M, Hans Vija A, Pagenstert G, Wild D, Kretzschmar M. Accuracy comparison of various quantitative [ 99mTc]Tc-DPD SPECT/CT reconstruction techniques in patients with symptomatic hip and knee joint prostheses. EJNMMI Res 2021; 11:60. [PMID: 34128128 PMCID: PMC8203767 DOI: 10.1186/s13550-021-00794-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for better diagnostic tools that identify loose total hip and knee arthroplasties. Here, we present the accuracy of different 99mTc-dicarboxypropandiphosphate ([99mTc]Tc-DPD) SPECT/CT quantification tools for the detection of loose prostheses in patients with painful hip and knee arthroplasties. METHODS Quantitative reconstruction of mineral phase SPECT data was performed using Siemens xSPECT-Quant and xSPECT-Bone, with and without metal artefact reduction (iMAR) of CT-data. Quantitative data (SUVmax values) were compared to intraoperative diagnosis or clinical outcome after at least 1 year as standard of comparison. Cut-off values and accuracies were calculated using receiver operator characteristics. Accuracy of uptake quantification was compared to the accuracy of visual SPECT/CT readings, blinded for the quantitative data and clinical outcome. RESULTS In this prospective study, 30 consecutive patients with 33 symptomatic hip and knee prostheses underwent [99mTc]Tc-DPD SPECT/CT. Ten arthroplasties were diagnosed loose and 23 stable. Mean-SUVmax was significantly higher around loose prostheses compared to stable prostheses, regardless of the quantification method (P = 0.0025-0.0001). Quantification with xSPECT-Bone-iMAR showed the highest accuracy (93.9% [95% CI 79.6-100%]) which was significantly higher compared to xSPECT-Quant-iMAR (81.8% [67.5-96.1%], P = 0.04) and xSPECT-Quant without iMAR (77.4% [62.4-92.4%], P = 0.02). Accuracies of clinical reading were non-significantly lower compared to quantitative measures (84.8% [70.6-99.1%] (senior) and 81.5% [67.5-96.1%] (trainee)). CONCLUSION Quantification with [99mTc]Tc-DPD xSPECT-Bone-iMAR discriminates best between loose and stable prostheses of all evaluated methods. The overall high accuracy of different quantitative measures underlines the potential of [99mTc]Tc-DPD-quantification as a biomarker and demands further prospective evaluation in a larger number of prosthesis.
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Affiliation(s)
- Martin Braun
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Michal Cachovan
- Siemens Healthcare GmbH, Molecular Imaging, Forchheim, Germany
| | - Felix Kaul
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Federico Caobelli
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Markus Bäumer
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - A. Hans Vija
- Siemens Medical Solutions USA, Inc., Molecular Imaging, Hoffman Estates, USA
| | - Geert Pagenstert
- Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Damian Wild
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Kretzschmar
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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Gömöri A, Gombos J, Papp M. An unusual case of hip pain after total hip arthroplasty: A case report. Jt Dis Relat Surg 2021; 32:546-550. [PMID: 34145838 PMCID: PMC8343858 DOI: 10.52312/jdrs.2021.79868] [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] [Received: 11/10/2020] [Accepted: 01/14/2021] [Indexed: 11/14/2022] Open
Abstract
Our goal is to draw attention to the inflammation of the iliopectineal bursa being a rare condition, which can cause lower limb swelling and anterior pain of the hip even years after total hip arthroplasty. A 67-year-old woman was admitted seven years after hip arthroplasty (cemented total endoprosthesis [TEP]) with swelling and feeling of excessive fullness of the lower extremity and with tolerable anterior hip pain. The physical examination and blood tests were non-specific for septic condition. Ultrasound showed a cystic mass in the inguinal region with a direct contact to the common femoral vein. Deep vein thrombosis was excluded. The single-photon emission computed tomography-computed tomography (SPECT-CT) was administered to decide the surgical plan, either making a bursa extirpation or making revision hip arthroplasty. The SPECT-CT excluded the possibility of aseptic loosening. Methylene blue was injected into the bursa intraoperatively which did not enter the strong pseudo-capsule of the joint and, therefore, we did not administer revision of the TEP, and the bursa was extirpated. Two weeks after the operation, the patient had no pain, was able to walk, and the swelling decreased. Four months after surgery, the pain and feeling of fullness disappeared, with minimal lower limb swelling. In conclusion, in case of increasing complaints of patients who left years behind without any problem following total hip arthroplasty, the pathogenic role of the iliopectineal bursa should be taken into account, after excluding more frequent causes such as aseptic loosening or periprosthetic joint infection. As long as we consider about a rare disease, we can find a solution to the patient's complaint sooner.
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Affiliation(s)
- András Gömöri
- Department of Traumatology, County Hospital and University Hospital, 3526 Szentpéteri kapu, Miskolc, Hungary.
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Beel W, Klaeser B, Kalberer F, Meier C, Wahl P. The Effect of a Distal Centralizer on Cemented Femoral Stems in Arthroplasty Shown on Radiographs and SPECT/CT: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00098. [PMID: 34101664 DOI: 10.2106/jbjs.cc.20.00973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 70-year-old female patient underwent total hip arthroplasty (HA) using a stem cemented line-to-line without centralizer. Postoperatively, she complained of load-dependent thigh pain. Conventional radiographs identified cortical overload because of a distal cement mantle discontinuity at the level of the stem's tip, confirmed by single-photon emission computed tomography/computed tomography scan (SPECT/CT). After cement-in-cement revision using a stem with centralizer, pain ceased rapidly. The cortical overload disappeared, as confirmed on a following SPECT/CT performed for low back pain. CONCLUSION In HA, the stem's tip may cause overload on the bone's cortex if the cement mantle is incomplete. Implanting a stem with centralizer avoids or cures this.
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Affiliation(s)
- Wouter Beel
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Bernd Klaeser
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, Switzerland
| | - Fabian Kalberer
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Christoph Meier
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Mertens J, Lootens T, Vercruysse J, Van Den Bossche B, Berwouts D, Lambert B, Van den Wyngaert T. Bone SPECT/CT in the Evaluation of Painful Total Ankle Replacement: Validation of Localization Scheme and Preliminary Evaluation of Diagnostic Patterns. Clin Nucl Med 2021; 46:361-368. [PMID: 33630798 DOI: 10.1097/rlu.0000000000003545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Third-generation total ankle replacement (TAR) is an increasingly popular and effective treatment for end-stage osteoarthritis, yet identifying causes of failure remains challenging. We evaluated integrated bone SPECT/CT in recurrent pain after TAR by validating a standardized reporting scheme, identifying uptake patterns, and assessing diagnostic performance and impact on clinical management. PATIENTS AND METHODS A total of 24 TARs in 16 patients with persistent or recurrent pain received integrated bone SPECT/CT using diagnostic CT settings. Images were retrospectively reviewed, and a novel localization scheme was validated by assessing interrater agreement. Distinct uptake patterns were identified, and diagnostic test characteristics were estimated. Reference standard consisted of clinical follow-up, laboratory findings, and subsequent procedures, including revision surgery. RESULTS Standardized scoring of bone SPECT/CT uptake was highly reproducible (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.75-0.82). The final diagnoses were gutter impingement (n = 12), periprosthetic (stress) fracture (n = 5), loosening (n = 5), tarsal arthritis (n = 1), and erysipelas (n = 1). Overall, the diagnostic test characteristics of bone SPECT/CT were as follows: sensitivity of 100% (95% CI, 82%-100%), specificity of 80% (95% CI, 28%-99%), and accuracy of 96% (95% CI, 79%-100%). Gutter impingement, periprosthetic fracture, and loosening were correctly identified in all cases revealing distinct uptake patterns. Importantly, persistent diffuse uptake was frequently observed, warranting cautious interpretation. Bone SPECT/CT impacted clinical management in 86%, with symptomatic improvement in 83% of patients. CONCLUSIONS Integrated bone SPECT/CT of painful TARs may benefit from standardized localization to reveal distinct uptake patterns representing common complications after TAR. Initial results show highly promising diagnostic value with potentially important impact on clinical management.
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An YS, Park DY, Min BH, Lee SJ, Yoon JK. Comparison of bone single-photon emission computed tomography (SPECT)/CT and bone scintigraphy in assessing knee joints. BMC Med Imaging 2021; 21:60. [PMID: 33771130 PMCID: PMC8004469 DOI: 10.1186/s12880-021-00590-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study attempted to compare the radiopharmaceutical uptake findings of planar bone scintigraphy (BS) and single photon emission computed tomography (SPECT)/computed tomography (CT) performed on knee joints. METHODS We retrospectively included 104 patients who underwent bone SPECT/CT and BS 4 h after the intravenous administration of technetium-99m-hydroxymethylene diphosphonate (99mTc-HDP) for pain in the knee joint. The uptake degree of each of the knee regions (medial femoral, lateral femoral, medial tibial, lateral tibial, and patellar area) in planar images and SPECT/CT were evaluated by visual (grades 0 to 2) and quantitative analyses (uptake counts for planar image and standardized uptake values [SUVs] for SPECT/CT). RESULTS The uptake grades assessed visually on the planar images differed significantly from the uptake grades on SPECT/CT images in all areas of the knee (all p < 0.001), and SPECT/CT imaging revealed a larger number of uptake lesions than those noted in planar imaging for each patient (3.3 ± 2.0 vs 2.4 ± 2.3, p < 0.0001). In all regions of the knee, all of the quantitative values, including uptake counts obtained from the planar image as well as the maximum SUV (SUVmax) and mean SUV (SUVmean) obtained from SPECT/CT, showed statistically higher values as their visual grades increased (all p < 0.001). However, when analyzed for each area, only the SUVmax showed a significant difference by grade in all knee regions. Quantitative uptake values obtained from planar images were moderately correlated with SUVs of SPECT/CT images (r = 0.58 for SUVmean and r = 0.53 for SUVmax, all p < 0.001) in the total knee regions. Looking at each area, there was a significant but low correlation between the uptake counts of the planar images and the SUVs on SPECT/CT in the right lateral tibial region (r = 0.45 for SUVmean, r = 0.31 for SUVmax, all p < 0.001). CONCLUSIONS In assessing knee joints, the findings of planar images and SPECT/CT images differ both visually and quantitatively, and more lesions can be found in SPECT/CT than in the planar images. The SUVmax could be a reliable value to evaluate knee joint uptake activity.
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Affiliation(s)
- Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Ajou University, 206, World cup-ro, Yeongtong-gu, Suwon-si, Suwon, Gyeonggi-do, 16499, Korea.
| | - Do Young Park
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Byoung-Hyun Min
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Su Jin Lee
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Ajou University, 206, World cup-ro, Yeongtong-gu, Suwon-si, Suwon, Gyeonggi-do, 16499, Korea
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging, School of Medicine, Ajou University, 206, World cup-ro, Yeongtong-gu, Suwon-si, Suwon, Gyeonggi-do, 16499, Korea
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Raynor WY, Borja AJ, Hancin EC, Werner TJ, Alavi A, Revheim ME. Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET. PET Clin 2021; 16:295-311. [PMID: 33589389 DOI: 10.1016/j.cpet.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PET imaging with 18F-sodium fluoride (NaF), combined with computed tomography or magnetic resonance, is a sensitive method of assessing bone turnover. Although NaF-PET is gaining popularity in detecting prostate cancer metastases to bone marrow, osseous changes represent secondary effects of cancer cell growth. PET tracers more appropriate for assessing prostate cancer metastases directly portray malignant activity and include 18F-fluciclovine and prostatic specific membrane antigen ligands. Recent studies investigating NaF-PET suggest utility in the assessment of benign musculoskeletal disorders. Emerging applications in assessing traumatic injuries, joint disease, back pain, orthopedic complications, and metabolic bone disease are discussed.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway.
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Clinical usefulness of single photon emission tomography/computed tomography with stress analysis in early diagnoses of stem instability of noncemented hip arthroplasty. Nucl Med Commun 2020; 42:244-252. [PMID: 33306622 DOI: 10.1097/mnm.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hip pain arising from implant instability is generally caused by repetitive stress injury, which subsequently leads to induction or exacerbation of abnormal metabolism of bone around the implant. single photon emission tomography/computed tomography (SPECT-CT) has advantages in localizing areas of increased tracer uptake that reflects such abnormal bone metabolism. Therefore, we investigated whether the application of SPECT/CT with stress analysis can be an effective practice in evaluating the instability of stem in noncemented hip arthroplasty or not. METHOD In total 16 patients were collected for unexplained painful hip arthroplasties. When physical examination and blood tests were unremarkable, radiographs were inconclusive and bone scan indicated increased scintigraphic uptake at the proximal part and at the tip of the stem; SPECT/CT was performed. Stem stability was assessed by measuring whether there was consistency between the increased scintigraphic uptake and the direction of the stress around the implant along with the location of the prosthesis. RESULT Among the 16 symptomatic hips, 9 hips showed the stability of the stem, 3 hips showed the stem instability and 4 hips showed the acetabular loosening with the stem stability. With the application of SPECT/CT with stress analysis, 15 out of 16 (93.7%) cases were found to have the change in the diagnoses, and managements were implemented in 11 out of 16 (68.7%) cases. When comparing before and after SPECT/CT, there was no significant association in clinical diagnosis and management (Pearson chi- square test = 4.61 and 1.33, P = 0.33 and 0.25). CONCLUSION SPECT/CT combined with stress analysis can be a useful tool in early diagnosis of stem instability and can assist surgeons in subsequent management and decision implementation when other radiographic imagings are inconclusive.
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Lima TVM, Bhure U, Pérez Lago MDS, Thali Y, Matijasevic S, Roos J, Strobel K. Impact of metal implants on xSPECT/CT Bone reconstruction: the "shining metal artefact". Eur J Hybrid Imaging 2020; 4:18. [PMID: 34191170 PMCID: PMC8218054 DOI: 10.1186/s41824-020-00087-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine. With xSPECT Bone, the reconstructed emission image is enhanced by the information obtained in the corresponding CT image. The CT defines tissue classes according to the Hounsfield units. In the iterative reconstruction, each tissue class is handled separately in the forward projection step, and all together in the back projection step. As a consequence, xSPECT Bone reconstruction generates images with improved boundary delineation and better anatomic representation of tracer activity. Applying this technique, however, showed that artefacts may occur, when no uptake regions, like metal implants, exhibit fictitious uniform tracer uptake. Due to limitations in spatial resolution in gamma cameras, the xSPECT Bone reconstructed image resulted in spill-out activity from surrounding high uptake region being uniformly distributed over the metal implants. This new technology of xSPECT Bone reconstruction in general enhances the image quality of SPECT/CT; however, the potential introduction of specific artefacts which inadvertently come along with this new technology and their frequency have not yet been addressed in the literature. Therefore, the purpose of this work was to identify and characterize these specific metal artefacts (the so-called shining metal artefact) in order to reduce false positives and avoid potentially misdiagnosing loosened or infected implants. Case presentation In this work, we report five cases imaged with bone SPECT/CT of 5 anatomical regions (foot, elbow, spine, shoulder, ribs and knee). All cases demonstrated “shining metal artefacts” in xSPECT Bone reconstruction. Conclusion While xSPECT Bone reconstruction algorithm significantly improves image quality for the diagnosis of bone and joint disorders with SPECT/CT, specific “shining metal artefacts” caused by the xSPECT Bone have to be recognized in order to avoid image misinterpretation suggesting metallic implant loosening or possible infection. The simultaneous analysis of conventionally reconstructed SPECT images (for Siemens the Flash3D reconstruction) helps to avoid misinterpretation of potential artefacts introduced by xSPECT Bone reconstruction.
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Affiliation(s)
- Thiago V M Lima
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland. .,Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Ujwal Bhure
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Yannick Thali
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Savo Matijasevic
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Justus Roos
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Klaus Strobel
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
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19
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Suarez Fernandez JP. Comments on “Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement)”. Eur J Nucl Med Mol Imaging 2020; 47:2501-2502. [DOI: 10.1007/s00259-020-04889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022]
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20
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Schuldt A, Lehnick D, Agten CA, Beck M, Kist M, Bhure U, Del Sol Pérez Lago M, Strobel K. Performance of radiography and single-photon emission computed tomography/computed tomography in painful total hip arthroplasty and impact on arthroplasty survival. Nucl Med Commun 2020; 41:875-882. [PMID: 32796475 DOI: 10.1097/mnm.0000000000001244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the performance of radiography and single-photon emission computed tomography/computed tomography (SPECT/CT) in painful hip arthroplasty regarding loosening and arthroplasty survival. METHODS Radiography and SPECT/CT reports of 249 painful hip arthroplasties of 191 patients were reviewed. Positive imaging was defined if loosening, infection, and polyethylene wear were found, indicating the need for arthroplasty exchange. Median time from radiograph to operation or last follow-up was 41.3 months (range 0.3-118.4 months). In 67 patients, the performance of radiographs and SPECT/CT regarding loosening was compared with an intraoperative reference standard. The time point of arthroplasty exchange was compared with imaging diagnosis and evaluated with Kaplan-Meier curves. RESULTS Exchange of cup, shaft, or both was performed in 76 of 249 arthroplasties. Main diagnoses on SPECT/CT were loosening (n = 94), infection (n = 5), and polyethylene wear (n = 15). In total, 104 patients were SPECT/CT positive compared to 84 patients on radiography. Five-year survival of arthroplasties for radiograph positive and negative arthroplasties was 41.5%/83.4% and 39.3%/90.7% for SPECT/CT, respectively. Prognostic impact regarding arthroplasty exchange was highest in radiograph and SPECT/CT concordant positive patients (hazard ratio 19.7 as compared to radiograph and SPECT/CT negative patients). Sensitivity and specificity in 67 operated patients regarding shaft loosening were 59.4%/80.0% with radiography, 90.6%/68.6% with SPECT/CT (P = 0.002 for sensitivity and P = 0.29 for specificity), and for cup loosening 47.4%/89.6% with radiography and 63.2%/85.4% with SPECT/CT (P = 0.51, respectively, P = 0.63). CONCLUSION In patients with painful hip arthroplasty, positive radiography, and SPECT/CT are associated with poorer arthroplasty survival. Performance regarding loosening is slightly better with SPECT/CT.
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Affiliation(s)
- Anna Schuldt
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
| | - Dirk Lehnick
- Biostatistics and Methodology, University of Lucerne
| | | | - Martin Beck
- Orthopaedic Surgery and Traumatology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Markus Kist
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
| | - Ujwal Bhure
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
| | | | - Klaus Strobel
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
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21
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Gislason MK, Lupidio F, Jónsson H, Cristofolini L, Esposito L, Bifulco P, Fraldi M, Gargiulo P. Three dimensional bone mineral density changes in the femur over 1 year in primary total hip arthroplasty patients. Clin Biomech (Bristol, Avon) 2020; 78:105092. [PMID: 32590143 DOI: 10.1016/j.clinbiomech.2020.105092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare the bone mineral density changes between unmatched patients undergoing total hip arthroplasty receiving uncemented and cemented type of implants. Previous studies have used DEXA or a two dimensional analysis to estimate the bone quality following total joint replacement, whereas this study presents the changes in three dimensions. METHODS Fifty subjects both male and females receiving both cemented and uncemented type of implant were recruited. Two CT scans were taken of each subject, the first at 24 h post surgery and the second one 1 year after surgery. The scans were calibrated using a phantom converting the Hounsfield units to bone mineral density values in g/cm3. The two scans were registered together using anatomical landmarks and resliced to compare the two femurs in the identical frame of reference. The bone density gain and loss was calculated by comparing density values between the two sets of scans. FINDINGS The results showed that most of the bone loss was located around the Lesser Trochanter and some bone density gain at the distal tip of the implant. The three dimensional density changes occur differently between individuals and the study showed no correlation of bone loss with age. INTERPRETATION The bone loss occurred mostly at the proximal femur, which is in agreement with previously presented studies. By carrying out three dimensional analysis on the bone gain and loss on the femur, it is possible to identify the patients that are showing high degree of bone loss.
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Affiliation(s)
| | - Francesca Lupidio
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; University of Bologna, Department of Industrial Engineering, Italy
| | - Halldór Jónsson
- Landspitali University Hospital, Department of Orthopaedics, Iceland
| | | | - Luca Esposito
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Bifulco
- University of Naples Federico II, Department of Electrical Engineering and Information Technologies, Italy
| | - Massimiliano Fraldi
- University of Naples Federico II, Department of Structures for Engineering and Architecture, Italy
| | - Paolo Gargiulo
- Institute for Biomedical and Neural Engineering, Reykjavik University, Iceland; Department of Science, Landspitali University Hospital, Iceland
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Van den Wyngaert T, Elvas F, De Schepper S, Kennedy JA, Israel O. SPECT/CT: Standing on the Shoulders of Giants, It Is Time to Reach for the Sky! J Nucl Med 2020; 61:1284-1291. [PMID: 32620702 DOI: 10.2967/jnumed.119.236943] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Twenty years ago, SPECT/CT became commercially available, combining the strengths of both techniques: the diagnostic sensitivity of SPECT and the anatomic detail of CT. Other benefits initially included attenuation correction of SPECT reconstructions, ultimately evolving to correction techniques that would enable absolute tracer uptake quantification. Recent developments in SPECT hardware include solid-state digital systems with higher sensitivity and resolution, using novel collimator designs based on tungsten. Similar advances in CT technology have been introduced in hybrid SPECT/CT systems, replacing low-end x-ray tubes with high-end multislice CT scanners equipped with iterative reconstruction, metal artifact reduction algorithms, and dual-energy capabilities. More recently, the design of whole-body SPECT/CT systems has taken another major leap with the introduction of a ring-shaped gantry equipped with multiple movable detectors surrounding the patient. These exciting developments have fueled efforts to develop novel SPECT radiopharmaceuticals, creating new chelators and prosthetic groups for radiolabeling. Innovative SPECT radionuclide pairs have now become available for radiolabeling with the potential for use as theranostic agents. The growth of precision medicine and the associated need for accurate radionuclide treatment dosimetry will likely drive the use of SPECT/CT in the near future. In addition, expanding clinical applications of SPECT/CT in other areas such as orthopedics offer exciting opportunities. Although it is true that the SPECT/CT ecosystem has seen several challenges during its development over the past 2 decades, it is now a feature-rich and mature tool ready for clinical prime time.
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Affiliation(s)
- Tim Van den Wyngaert
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium .,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Filipe Elvas
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Stijn De Schepper
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - John A Kennedy
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel; and.,Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel
| | - Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel
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Computed Tomography (CT) Protocols Associated with Cardiac and Bone Single-Photon Emission Computed Tomography/CT (SPECT/CT) in Korea. Nucl Med Mol Imaging 2020; 54:139-146. [PMID: 32582397 DOI: 10.1007/s13139-020-00644-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Single-photon emission computed tomography/computed tomography (SPECT/CT) is an advanced hybrid nuclear medicine technology that generates both functional and anatomical images in a single study. As utilization of SPECT/CT in Korea has been increasing, the purpose of this study was to survey its application of cardiac and skeletal SPECT/CT imaging for protocol optimization. METHODS We surveyed CT protocols established for cardiac and skeletal SPECT/CT. We searched the guidelines for the CT protocols for SPECT/CT and reviewed the literature recently published. RESULTS Among 36 hybrid SPECT scanners equipped with four or more multi-channel detector CTs (MDCTs), 18 scanners were used to perform cardiac studies at both very low current CT (30-80 mA; 11.1%) and ultra-low current CT (13-30 mA; 88.9%). Among the 33 canners, very low current (≤ 80 mA) CT or low current CT (80-130 mA) was used in 23.5%, and 41.8% for spine disorders, and in 36.4% or 30.3% for foot/ankle disorders, respectively. In the CT reconstructions, slice thickness of 5 mm for cardiac studies was most commonly used (94.4%); thinner slices (0.6-1.0 mm) for spine and foot/ankle studies were used in 24.2% and 45.5%, respectively. We also reviewed the international guidelines. CONCLUSIONS The results and current recommendations will be helpful for optimizing CT protocols for SPECT/CT. Optimization of SPECT/CT protocols will be required for generating the proper strategy for the specific lesions and clinical purpose.
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Nuclear Medicine Imaging Techniques of the Musculoskeletal System. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Diagnosis of the failed total hip replacement. J Clin Orthop Trauma 2020; 11:2-8. [PMID: 32001976 PMCID: PMC6985031 DOI: 10.1016/j.jcot.2019.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/28/2019] [Indexed: 12/27/2022] Open
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Bäcker HC, Steurer-Dober I, Beck M, Agten CA, Decking J, Herzog RF, Geller JA, Bhure U, Roos JE, Strobel K. Magnetic resonance imaging (MRI) versus single photon emission computed tomography (SPECT/CT) in painful total hip arthroplasty: a comparative multi-institutional analysis. Br J Radiol 2019; 93:20190738. [PMID: 31642691 DOI: 10.1259/bjr.20190738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To investigate the value of MRI in comparison to single photon emission computed tomography (SPECT)/CT in patients with painful hip arthroplasties. METHODS A prospective, multi-institutional study was performed. Therefore, 35 consecutive patients (21 female, 14 male, mean age 61.8 ± 13.3 years) with 37-painful hip arthroplasties were included. A hip surgeon noted the most likely diagnosis based on clinical examination and hip radiographs. Then, MRI and SPECT/CT of the painful hips were acquired. MRI and SPECT/CT were assessed for loosening, infection, fracture, tendon pathology and other abnormalities. Final diagnosis and therapy was established by the hip surgeon after integration of MRI and SPECT/CT results. The value of MRI and SPECT/CT for diagnosis was assessed with a 3-point scale (1 = unimportant, 2 = helpful, 3 = essential). RESULTS Loosening was observed in 13/37 arthroplasties (6 shaft only, 6 cup only, 1 combined). Sensitivity, specificity, positive predictive value and negative predictive value for loosening of MRI were 86%/88%/60%/100% and of SPECT/CT 93%/97%/90%/100%, respectively. MRI and SPECT/CT diagnosed infection correctly in two of three patients and fractures in two patients, which were missed by X-ray. MRI detected soft tissue abnormalities in 21 patients (6 bursitis, 14 tendon lesions, 1 pseudotumor), of which only 1 tendon abnormality was accurately detected with SPECT/CT. All 5 arthroplasties with polyethylene wear were correctly diagnosed clinically and with both imaging modalities. MRI and SPECT/CT were judged as not helpful in 0/0%, as helpful in 16%/49% and essential in 84%/51%. CONCLUSION In patients with painful hip arthroplasty SPECT/CT is slightly superior to MR in the assessment of loosening. MRI is far superior in the detection of soft tissue, especially tendon pathologies. ADVANCES IN KNOWLEDGE To our knowledge this is the first prospective, multiinstitutional study which compares MRI with SPECT/CT in painful hip arthroplasties. We found that MRI is far superior in the detection of soft tissue pathologies, whereas SPECT/CT remains slightly superior regarding loosening.
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Affiliation(s)
- Henrik C Bäcker
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.,Orthopedic Surgery and Traumatology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Martin Beck
- Orthopedic Surgery and Traumatology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christoph A Agten
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Jens Decking
- Orthopedic Surgery, Cantonal Hospital Lucerne, Sursee, Switzerland
| | - Richard F Herzog
- Orthopedic Surgery, Cantonal Hospital Lucerne, Wolhusen, Switzerland
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, Columbia University Medical Center/ Presbyterian Hospital, New York, United States
| | - Ujwal Bhure
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Justus E Roos
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Klaus Strobel
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Liu H, Dai G, Pu F. Hip-Joint CT Image Segmentation Based on Hidden Markov Model with Gauss Regression Constraints. J Med Syst 2019; 43:309. [PMID: 31446505 DOI: 10.1007/s10916-019-1439-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/20/2019] [Indexed: 11/24/2022]
Abstract
Hip-joint CT images have low organizational contrast, irregular shape of boundaries and image noises. Traditional segmentation algorithms often require manual intervention or introduction of some prior information, which results in low efficiency and is unable to meet clinical needs. In order to overcome the sensitivity of classical fuzzy clustering image segmentation algorithm to image noise, this paper proposes a fuzzy clustering image segmentation algorithm combining Gaussian regression model (GRM) and hidden Markov random field (HMRF). The algorithm uses the prior information to regularize the objective function of the fuzzy C-means, and then improves it with KL information. The HMRF model establishes the neighborhood relationship of the label field by prior probability, while CRM model establishes the neighborhood relationship of feature field on the basis of the consistency between the central pixel label and its neighborhood pixel label. The experimental results show that the proposed algorithm has high segmentation accuracy.
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Affiliation(s)
- Haiyang Liu
- Department of Radiology, Shangluo Central Hospital, Shangluo, 726000, Shaanxi, China
| | - Guochao Dai
- Image Center of the First People's Hospital of Kashgar, Kashgar, Xinjiang, 844000, China
| | - Fushun Pu
- Southern Central Hospital of Yunnan Province (The First People's Hospital of Honghe State), Mengzi, 661199, Yunnan, China.
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Mushtaq N, To K, Gooding C, Khan W. Radiological Imaging Evaluation of the Failing Total Hip Replacement. Front Surg 2019; 6:35. [PMID: 31275942 PMCID: PMC6591276 DOI: 10.3389/fsurg.2019.00035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023] Open
Abstract
Total hip replacements (THR) have been performed in the UK from the 1960s and since then we have seen surgical techniques, the design of implants, and imaging modalities rapidly develop. This paper will aim to review the different complications and imaging appearance which help to evaluate each problem. As for all investigations for bone and joints, a radiograph is the first imaging to be performed for any patient with a THR and can detect a majority of complications. CT is relatively low-cost, simple to perform and easily available making it an excellent tool to supplement radiographs when trying to evaluate a hip prosthesis. Single photon emission computed tomography with CT (SPECT-CT) is an emerging modality which has shown to combine the sensitivity that bone scintigraphy offers with the high specificity of CT. SPECT imaging also has the advantage of showing the bone's metabolic activity and is less prone to metal artifact than Magnetic resonance imaging (MRI). MRI has evolved to become an important diagnostic tool for the evaluation of THR in the post-operative period. Optimized pulse sequences and metal artifact reduction techniques have made MRI a useful tool in diagnosis of soft tissue abnormalities and is particularly useful in identifying adverse local tissue reactions in metal on metal implants. CT and MRI are accurate in identifying the diagnosis of most causes of THR complications except infection. Research confirms that leukocyte-marrow scintigraphy is the modality of choice for accurately diagnosing prosthetic joint infection and reassures us of its superiority over other nuclear medicine imaging. However, due to the limited availability and increased costs when performing leukocyte-marrow scintigraphy, CT and SPECT-CT would be a more preferred option when suspecting prosthesis infection. Ultrasound (US) has a limited role in the assessment of most THR complications but can be useful to identify peri-prosthetic fluid collections and the presence of soft tissue sinus tracts. Being aware of the imaging modalities that are available to orthopedic surgeons, and discussing these challenging cases with specialist radiologists will enable optimal management of THR complications.
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Affiliation(s)
- Nida Mushtaq
- Department of Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, United Kingdom
| | - Kendrick To
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Chris Gooding
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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