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Al-Jabri T, Ridha M, Wood MJ, Kayani B, Jayadev C, McCulloch RA, Schemitsch E. An overview of the current diagnostic approach to Periprosthetic Joint Infections. Orthop Rev (Pavia) 2024; 16:120308. [PMID: 38957745 PMCID: PMC11218870 DOI: 10.52965/001c.120308] [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: 11/13/2023] [Accepted: 03/24/2024] [Indexed: 07/04/2024] Open
Abstract
The diagnosis of periprosthetic joint infections (PJI) presents a formidable challenge to orthopaedic surgeons due to its complex and diverse manifestations. Accurate diagnosis is of utmost importance, as even mild pain following joint replacement surgery may indicate PJI in the absence of a definitive gold standard diagnostic test. Numerous diagnostic modalities have been suggested in the literature, and international societies have continually updated diagnostic criteria for this debilitating complication. This review article aims to comprehensively examine the latest evidence-based approaches for diagnosing PJI. Through a thorough analysis of current literature, we explore promising diagnostic strategies that have demonstrated effectiveness in identifying PJI. These strategies encompass the utilization of laboratory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), alongside imaging techniques such as magnetic resonance imaging (MRI) and leukocyte scintigraphy. Additionally, we highlight the importance of synovial fluid analysis, including the potential role of alpha-defensin as a biomarker, and examine evolving international diagnostic criteria to standardize and improve diagnostic accuracy.
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Affiliation(s)
- Talal Al-Jabri
- Department of Surgery and Cancer Imperial College London
| | | | | | | | - Chethan Jayadev
- Joint Reconstruction Unit Royal National Orthopaedic Hospital NHS Trust
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2
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Valero-Martínez C, Castillo-Morales V, Gómez-León N, Hernández-Pérez I, Vicente-Rabaneda EF, Uriarte M, Castañeda S. Application of Nuclear Medicine Techniques in Musculoskeletal Infection: Current Trends and Future Prospects. J Clin Med 2024; 13:1058. [PMID: 38398371 PMCID: PMC10889833 DOI: 10.3390/jcm13041058] [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: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Nuclear medicine has become an indispensable discipline in the diagnosis and management of musculoskeletal infections. Radionuclide tests serve as a valuable diagnostic tool for patients suspected of having osteomyelitis, spondylodiscitis, or prosthetic joint infections. The choice of the most suitable imaging modality depends on various factors, including the affected area, potential extra osseous involvement, or the impact of previous bone/joint conditions. This review provides an update on the use of conventional radionuclide imaging tests and recent advancements in fusion imaging scans for the differential diagnosis of musculoskeletal infections. Furthermore, it examines the role of radionuclide scans in monitoring treatment responses and explores current trends in their application. We anticipate that this update will be of significant interest to internists, rheumatologists, radiologists, orthopedic surgeons, rehabilitation physicians, and other specialists involved in musculoskeletal pathology.
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Affiliation(s)
- Cristina Valero-Martínez
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
| | - Valentina Castillo-Morales
- Nuclear Medicine Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (V.C.-M.); (I.H.-P.)
| | - Nieves Gómez-León
- Radiology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain;
| | - Isabel Hernández-Pérez
- Nuclear Medicine Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (V.C.-M.); (I.H.-P.)
| | - Esther F. Vicente-Rabaneda
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
| | - Miren Uriarte
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
| | - Santos Castañeda
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
- Cathedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
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3
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Walker EA, Fox MG, Blankenbaker DG, French CN, Frick MA, Hanna TN, Jawetz ST, Onks C, Said N, Stensby JD, Beaman FD. ACR Appropriateness Criteria® Imaging After Total Knee Arthroplasty: 2023 Update. J Am Coll Radiol 2023; 20:S433-S454. [PMID: 38040463 DOI: 10.1016/j.jacr.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristy N French
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Tarek N Hanna
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | | | - Cayce Onks
- Penn State Health, Hershey, Pennsylvania, Primary care physician
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
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4
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Wang Y, Yuan L, Du Y, Liu H, Li Q, Chang Y, Shi Y, Wang Y, Meng X, Zhou Y, Yao S, Tian J. Performance characteristics of 18F-fluorodeoxyglucose in non-infected hip replacement. Front Med (Lausanne) 2023; 9:1043812. [PMID: 36698792 PMCID: PMC9870722 DOI: 10.3389/fmed.2022.1043812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose The aim of this study was to retrospectively analyze 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/ computed tomography (CT) images of non-infected hip arthroplasty patients and summarize findings that may be useful for clinical practice. Methods 18F-FDG PET/CT images of non-infected hip arthroplasty patients were collected from September 2009 to August 2021. The region of interest was independently delineated by two physicians and maximum standardized uptake values (SUVmax) were recorded and compared. Serologic data were also collected and the correlation between SUVmax and serologic parameters was analyzed, while the images were classified based on the 18F-FDG uptake pattern in the images using the diagnostic criteria proposed by Reinartz et al. (9). The interval between hip replacement and PET/CT was classified by year and the characteristics of the two groups were compared. The images of patients who underwent PET/CT multiple times were analyzed dynamically. Results A total of 121 examinations were included; six patients underwent PET/CT twice and two patients had three scans. There were no significant correlations between SUVmax and serologic results. The interobserver agreement between the two physicians in the classification according to the criteria of Reinartz et al. (9) was 0.957 (P < 0.005). Although there was non-specific uptake in cases with an arthroplasty-to-PET/CT interval this was non-significant. Additionally, 18F-FDG showed potential utility for dynamic observation of the condition of the hip. Conclusion SUVmax provided information independent of serologic results, meanwhile 18F-FDG showed potential applicability to the dynamic monitoring of hip arthroplasty-related diseases. However, the presence of blood vessels and muscles affected image interpretation and the specificity of 18F-FDG was not optimal. A more specific radionuclide is needed to maximize the benefits of using PET/CT for the assessment of periprosthetic joint infection (PJI).
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Affiliation(s)
- Yiqun Wang
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Lulu Yuan
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yinqiao Du
- Department of Orthopedics Surgery, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Department of Orthopedics Surgery, The Fourth Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Honghong Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Qingxiao Li
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yan Chang
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Yan Chang,
| | - Yuanyuan Shi
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Yanmei Wang
- General Electric (GE) Healthcare China, Shanghai, China
| | - Xiaolin Meng
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yonggang Zhou
- Department of Orthopedics Surgery, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Department of Orthopedics Surgery, The Fourth Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Yonggang Zhou,
| | - Shulin Yao
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Shulin Yao,
| | - Jiahe Tian
- Department of Nuclear Medicine, The First Medical Centre, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China,Jiahe Tian,
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5
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Xi Z, Liu T, Shi H, Jiao Z. Hypergraph representation of multimodal brain networks for patients with end-stage renal disease associated with mild cognitive impairment. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:1882-1902. [PMID: 36899513 DOI: 10.3934/mbe.2023086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The structure and function of brain networks (BN) may be altered in patients with end-stage renal disease (ESRD). However, there are relatively few attentions on ESRD associated with mild cognitive impairment (ESRDaMCI). Most studies focus on the pairwise relationships between brain regions, without taking into account the complementary information of functional connectivity (FC) and structural connectivity (SC). To address the problem, a hypergraph representation method is proposed to construct a multimodal BN for ESRDaMCI. First, the activity of nodes is determined by connection features extracted from functional magnetic resonance imaging (fMRI) (i.e., FC), and the presence of edges is determined by physical connections of nerve fibers extracted from diffusion kurtosis imaging (DKI) (i.e., SC). Then, the connection features are generated through bilinear pooling and transformed into an optimization model. Next, a hypergraph is constructed according to the generated node representation and connection features, and the node degree and edge degree of the hypergraph are calculated to obtain the hypergraph manifold regularization (HMR) term. The HMR and L1 norm regularization terms are introduced into the optimization model to achieve the final hypergraph representation of multimodal BN (HRMBN). Experimental results show that the classification performance of HRMBN is significantly better than that of several state-of-the-art multimodal BN construction methods. Its best classification accuracy is 91.0891%, at least 4.3452% higher than that of other methods, verifying the effectiveness of our method. The HRMBN not only achieves better results in ESRDaMCI classification, but also identifies the discriminative brain regions of ESRDaMCI, which provides a reference for the auxiliary diagnosis of ESRD.
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Affiliation(s)
- Zhengtao Xi
- School of Microelectronics and Control Engineering, Changzhou University, Changzhou 213164, China
| | - Tongqiang Liu
- Department of Nephrology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213003, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213003, China
| | - Zhuqing Jiao
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou 213164, China
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6
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Rachh SS, Basu S, Alavi A. Fluorodeoxyglucose PET/Computed Tomography in Evaluation of Prosthetic Joints and Diabetic Foot: A Comparative Perspective with Other Functional Imaging Modalities. PET Clin 2022; 17:517-531. [PMID: 35717105 DOI: 10.1016/j.cpet.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Infection imaging has been an important part of nuclear medicine practice. Infections in prosthetic joints and diabetic foot are associated with devastating complications, posing substantial challenge for both diagnosis and overall management. For many years, conventional nuclear medicine techniques have been used to frame a painful joint arthroplasty or diabetic foot infection. The various functional nuclear imaging modalities used include labeled leukocyte imaging, combined leukocyte-marrow scintigraphy, antigranulocyte antibody scintigraphy, 3-phase bone scintigraphy, and fluorodeoxyglucose PET/computed tomography, yet no single method has proved to be highly sensitive and specific and at the same time safe, simple, and time-effective.
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Affiliation(s)
- Swati Sodagar Rachh
- Department of Nuclear Medicie, Gujarat Cancer & Research Institute, Civil Hospital Campus, Asarwa, Ahmedabad 380016, India; Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Parel, Mumbai, India
| | - Sandip Basu
- Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Parel, Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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7
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Xu T, Zeng Y, Yang X, Liu G, Lv T, Yang H, Jiang F, Chen Y. Application of 68Ga-citrate PET/CT for differentiating periprosthetic joint infection from aseptic loosening after joint replacement surgery. Bone Joint Res 2022; 11:398-408. [PMID: 35731211 PMCID: PMC9233412 DOI: 10.1302/2046-3758.116.bjr-2021-0464.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS We aimed to evaluate the utility of 68Ga-citrate positron emission tomography (PET)/CT in the differentiation of periprosthetic joint infection (PJI) and aseptic loosening (AL), and compare it with 99mTc-methylene bisphosphonates (99mTc-MDP) bone scan. METHODS We studied 39 patients with suspected PJI or AL. These patients underwent 68Ga-citrate PET/CT, 99mTc-MDP three-phase bone scan and single-photon emission CT (SPECT)/CT. PET/CT was performed at ten minutes and 60 minutes after injection, respectively. Images were evaluated by three nuclear medicine doctors based on: 1) visual analysis of the three methods based on tracer uptake model, and PET images attenuation-corrected with CT and those not attenuation-corrected with CT were analyzed, respectively; and 2) semi-quantitative analysis of PET/CT: maximum standardized uptake value (SUVmax) of lesions, SUVmax of the lesion/SUVmean of the normal bone, and SUVmax of the lesion/SUVmean of the normal muscle. The final diagnosis was based on the clinical and intraoperative findings, and histopathological and microbiological examinations. RESULTS Overall, 23 and 16 patients were diagnosed with PJI and AL, respectively. The sensitivity and specificity of three-phase bone scan and SPECT/CT were 100% and 62.5%, 82.6%, and 100%, respectively. Attenuation correction (AC) at 60 minutes and non-AC at 60 minutes of PET/CT had the same highest sensitivity and specificity (91.3% and 100%), and AC at 60 minutes combined with SPECT/CT could improve the diagnostic efficiency (sensitivity = 95.7%). Diagnostic efficacy of the SUVmax was low (area under the curve (AUC) of ten minutes and 60 minutes was 0.814 and 0.806, respectively), and SUVmax of the lesion/SUVmean of the normal bone at 60 minutes was the best semi-quantitative parameter (AUC = 0.969). CONCLUSION 68Ga-citrate showed the potential to differentiate PJI from AL, and visual analysis based on uptake pattern of tracer was reliable. The visual analysis method of AC at 60 minutes, combined with 99mTc-MDP SPECT/CT, could improve the sensitivity from 91.3% to 95.7%. In addition, a major limitation of our study was that it had a limited sample size, and more detailed studies with a larger sample size are warranted. Cite this article: Bone Joint Res 2022;11(6):398-408.
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Affiliation(s)
- Tingting Xu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Yalan Zeng
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiao Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Guangfu Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Taiyong Lv
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Hongbin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fei Jiang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
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8
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Imaging for detection of osteomyelitis in people with diabetic foot ulcers: A systematic review and meta-analysis. Eur J Radiol 2020; 131:109215. [PMID: 32862106 DOI: 10.1016/j.ejrad.2020.109215] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/09/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Osteomyelitis is an infection of the bone which can occur in people with diabetic foot ulcers. It can be diagnosed using X-rays, ultrasound, scintigraphy, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET). OBJECTIVES To review the evidence on the diagnostic accuracy of imaging tests to diagnose osteomyelitis in people with diabetic foot ulcers. METHODS We conducted a systematic review and meta-analysis. MEDLINE, EMBASE and other databases were searched to July 2018. Risk of bias was evaluated. Diagnostic accuracy was estimated using bivariate meta-analyses. RESULTS Thirty-six studies were included in the meta-analysis. Eight studies were at high risk of bias MRI had high diagnostic accuracy (22 studies: 96.4 % sensitivity (95 % CI 90.7-98.7); 83.8 % specificity (76.0-89.5)). PET scans also had high accuracy (6 studies: 84.3 % sensitivity (52.8-96.3); 92.8 % specificity (75.7-98.2)), and possibly also SPECT, but with few studies (3 studies: 95.6 % sensitivity (76.0-99.3); 55.1 % specificity (19.3-86.3)). Scintigraphy (17 studies: 84.2 % sensitivity (76.8-89.6); 67.7 % specificity (56.2-77.4)), and X-rays (16 studies: 61.9 % sensitivity (50.5-72.1); 78.3 % specificity (62.9-88.5)) had generally inferior diagnostic accuracy. CONCLUSIONS MRI and PET both reliably diagnose osteomyelitis in diabetic foot ulcer patients. SPECT may also have good diagnostic accuracy, although evidence is limited. This review confirms most current guidelines, showing that MRI may be the preferable test in most cases, given its wider availability and the lack of potentially harmful ionising radiation.
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9
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Hong FS, Fox LC, Chai KL, Htun K, Clucas D, Morgan S, Cole-Sinclair MF, Juneja S. Role of bone marrow biopsy for fever of unknown origin in the contemporary Australian context. Intern Med J 2020; 49:850-854. [PMID: 30350441 DOI: 10.1111/imj.14147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/23/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone marrow biopsy (BMB) is an accepted investigation in fever of unknown origin (FUO) to uncover haematological malignancies, such as lymphoma, and sometimes infections. With the advance in imaging modalities, such as 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) to identify the focus of lymphoma, BMB may not contribute to the diagnosis when there are no other clinical features to suggest an underlying haematological disease. AIM To investigate the utility of BMB in determining the cause of FUO, when there are no other indications for BMB. METHODS Medical records of adult patients who had BMB performed for FUO or febrile illness from 1 January 2005 to 31 December 2014 in four metropolitan tertiary hospitals in Melbourne, Australia were reviewed. Patients with other concurrent indications for BMB, known human immunodeficiency virus infection and previously diagnosed connective tissue diseases were excluded. RESULTS Seventy-three patients were included in the study. Fifty-one patients had a final diagnosis for fever (systemic inflammatory diseases, infective, malignancy or other) while 22 patients had no diagnoses. In only 10 patients (13.7%) did BMB contribute to the diagnosis, finding either malignancy or granulomata. However, all these diagnoses could have been made without BMB. Two patients with diffuse large B-cell lymphoma had normal BMB. FDG-PET was helpful in making a diagnosis in eight (25%) out of 32 patients. CONCLUSION Performing BMB in patients with FUO and no other haematological abnormalities is of very limited value, and other investigations, such as FDG-PET, may be more likely to help establish a definitive diagnosis.
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Affiliation(s)
- Frank S Hong
- Department of Laboratory Haematology, Austin Health, Victoria, Australia
| | - Lucy C Fox
- Department of Laboratory Haematology, Austin Health, Victoria, Australia
| | - Khai Li Chai
- Laboratory Haematology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Kay Htun
- Laboratory Haematology, Alfred Health, Victoria, Australia
| | - Danielle Clucas
- Diagnostic Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Susan Morgan
- Laboratory Haematology, Alfred Health, Victoria, Australia
| | | | - Surender Juneja
- Diagnostic Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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10
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Aguiar Ferreira A, Gomes P, Curvo-Semedo L, Donato P. Whipple's disease: imaging contribution for a challenging case. BMJ Case Rep 2020; 13:13/2/e233071. [PMID: 32047086 DOI: 10.1136/bcr-2019-233071] [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] [Indexed: 12/17/2022] Open
Abstract
Whipple's disease is a rare and difficult-to-diagnose infectious disease, related to infection by gram-positive bacillum Tropheryma whipplei Clinical manifestations are very variable, but the classic form usually begins with recurring arthritis, followed several years later by non-specific abdominal symptoms, leading to late diagnosis. We present the case of a 52-year-old man who was admitted in the emergency department with an insidious clinical picture characterised by weight loss, abdominal pain, diarrhoea and arthralgias. An abdominal ultrasound was performed, showing findings suggestive of Whipple's disease, which, in conjunction with the clinical and laboratory findings, allowed the diagnosis to be correctly addressed. Upper endoscopy with duodenal biopsy revealed findings compatible with Whipple's disease, and the diagnosis was also confirmed through PCR techniques of blood. The patient was given antibiotic therapy, with rapid and substantial clinical improvement.
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Affiliation(s)
| | - Paula Gomes
- Medical Imaging, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Luís Curvo-Semedo
- Medical Imaging, Coimbra University Hospital Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Paulo Donato
- Medical Imaging, Coimbra University Hospital Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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11
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Molecular Imaging of Inflammation and Infection. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Walker EA, Beaman FD, Wessell DE, Cassidy RC, Czuczman GJ, Demertzis JL, Lenchik L, Motamedi K, Pierce JL, Sharma A, Ying-Kou Yung E, Kransdorf MJ. ACR Appropriateness Criteria® Suspected Osteomyelitis of the Foot in Patients With Diabetes Mellitus. J Am Coll Radiol 2019; 16:S440-S450. [DOI: 10.1016/j.jacr.2019.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/16/2022]
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13
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Kiran M, Donnelly TD, Armstrong C, Kapoor B, Kumar G, Peter V. Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria. Bone Joint J 2019; 101-B:910-914. [PMID: 31362552 DOI: 10.1302/0301-620x.101b8.bjj-2018-0929.r2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. PATIENTS AND METHODS A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. RESULTS The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. CONCLUSION FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910-914.
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Affiliation(s)
- M Kiran
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - T D Donnelly
- Trauma and Orthopaedics, Royal Liverpool University Hospital, Liverpool, UK
| | - C Armstrong
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - B Kapoor
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - G Kumar
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - V Peter
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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15
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García Jiménez R, García-Gómez F, Noriega Álvarez E, Calvo Morón C, Martín-Marcuartu J. Hybrid imaging in foot and ankle disorders. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2017.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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17
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A Comparative 68Ga-Citrate and 68Ga-Chloride PET/CT Imaging of Staphylococcus aureus Osteomyelitis in the Rat Tibia. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:9892604. [PMID: 29681785 PMCID: PMC5845485 DOI: 10.1155/2018/9892604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/18/2018] [Indexed: 01/20/2023]
Abstract
There may be some differences in the in vivo behavior of 68Ga-chloride and 68Ga-citrate leading to different accumulation profiles. This study compared 68Ga-citrate and 68Ga-chloride PET/CT imaging under standardized experimental models. Methods. Diffuse Staphylococcus aureus tibial osteomyelitis and uncomplicated bone healing rat models were used (n = 32). Two weeks after surgery, PET/CT imaging was performed on consecutive days using 68Ga-citrate or 68Ga-chloride, and tissue accumulation was confirmed by ex vivo analysis. In addition, peripheral quantitative computed tomography and conventional radiography were performed. Osteomyelitis was verified by microbiological analysis and specimens were also processed for histomorphometry. Results. In PET/CT imaging, the SUVmax of 68Ga-chloride and 68Ga-citrate in the osteomyelitic tibias (3.6 ± 1.4 and 4.7 ± 1.5, resp.) were significantly higher (P = 0.0019 and P = 0.0020, resp.) than in the uncomplicated bone healing (2.7 ± 0.44 and 2.5 ± 0.49, resp.). In osteomyelitic tibias, the SUVmax of 68Ga-citrate was significantly higher than the uptake of 68Ga-chloride (P = 0.0017). In animals with uncomplicated bone healing, no difference in the SUVmax of 68Ga-chloride or 68Ga-citrate was seen in the operated tibias. Conclusions. This study further corroborates the use of 68Ga-citrate for PET imaging of osteomyelitis.
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18
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Wiehr S, Warnke P, Rolle AM, Schütz M, Oberhettinger P, Kohlhofer U, Quintanilla-Martinez L, Maurer A, Thornton C, Boschetti F, Reischl G, Autenrieth IB, Pichler BJ, Autenrieth SE. New pathogen-specific immunoPET/MR tracer for molecular imaging of a systemic bacterial infection. Oncotarget 2017; 7:10990-1001. [PMID: 26934329 PMCID: PMC4905453 DOI: 10.18632/oncotarget.7770] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/20/2016] [Indexed: 01/12/2023] Open
Abstract
The specific and rapid detection of Enterobacteriaceae, the most frequent cause of gram-negative bacterial infections in humans, remains a major challenge. We developed a non-invasive method to rapidly detect systemic Yersinia enterocolitica infections using immunoPET (antibody-targeted positron emission tomography) with [64Cu]NODAGA-labeled Yersinia-specific polyclonal antibodies targeting the outer membrane protein YadA. In contrast to the tracer [18F]FDG, [64Cu]NODAGA-YadA uptake co-localized in a dose dependent manner with bacterial lesions of Yersinia-infected mice, as detected by magnetic resonance (MR) imaging. This was accompanied by elevated uptake of [64Cu]NODAGA-YadA in infected tissues, in ex vivo biodistribution studies, whereas reduced uptake was observed following blocking with unlabeled anti-YadA antibody. We show, for the first time, a bacteria-specific, antibody-based, in vivo imaging method for the diagnosis of a Gram-negative enterobacterial infection as a proof of concept, which may provide new insights into pathogen-host interactions.
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Affiliation(s)
- Stefan Wiehr
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Philipp Warnke
- Institute of Medical Microbiology and Hygiene, Eberhard Karls University, Tübingen, Germany.,Institute of Medical Microbiology, Virology and Hygiene, Rostock University Hospital, Rostock, Germany
| | - Anna-Maria Rolle
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Monika Schütz
- Institute of Medical Microbiology and Hygiene, Eberhard Karls University, Tübingen, Germany
| | - Philipp Oberhettinger
- Institute of Medical Microbiology and Hygiene, Eberhard Karls University, Tübingen, Germany
| | - Ursula Kohlhofer
- Institute of Pathology, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Andreas Maurer
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christopher Thornton
- Biosciences and ISCA Diagnostics Ltd., University of Exeter, Exeter, United Kingdom
| | | | - Gerald Reischl
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Ingo B Autenrieth
- Institute of Medical Microbiology and Hygiene, Eberhard Karls University, Tübingen, Germany
| | - Bernd J Pichler
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stella E Autenrieth
- Department of Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
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19
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García Jiménez R, García-Gómez FJ, Noriega Álvarez E, Calvo Morón C, Martín-Marcuartu JJ. Hybrid imaging in foot and ankle disorders. Rev Esp Med Nucl Imagen Mol 2017; 37:191-202. [PMID: 29221678 DOI: 10.1016/j.remn.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/24/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Abstract
Disorders of the foot and ankle are some of the most frequent ones affecting the musculoskeletal system and have a great impact on patients' quality of life. Accurate diagnosis is an important clinical challenge because of the complex anatomy and function of the foot, that make it difficult to locate the source of the pain by routine clinical examination. In the study of foot pathology, anatomical imaging (radiography, magnetic resonance imaging [MRI], ultrasound and computed tomography [CT]) and functional imaging (bone scan, positron emission tomography [PET] and MRI) techniques have been used. Hybrid imaging combines the advantages of morphological and functional studies in a synergistic way, helping the clinician manage complex problems. In this article we delve into the anatomy and biomechanics of the foot and ankle and describe the potential indications for the current hybrid techniques available for the study of foot and ankle disease.
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Affiliation(s)
- R García Jiménez
- Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - F J García-Gómez
- Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - E Noriega Álvarez
- Medicina Nuclear, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - C Calvo Morón
- Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM.
| | - J J Martín-Marcuartu
- Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
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20
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Parisi MT, Otjen JP, Stanescu AL, Shulkin BL. Radionuclide Imaging of Infection and Inflammation in Children: a Review. Semin Nucl Med 2017; 48:148-165. [PMID: 29452618 DOI: 10.1053/j.semnuclmed.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the exception of radiolabeled monoclonal antibodies, antibody fragments and radiolabeled peptides which have seen little application in the pediatric population, the nuclear medicine imaging procedures used in the evaluation of infection and inflammation are the same for both adults and children. These procedures include (1) either a two- or a three-phase bone scan using technetium-99m methylene diphosphonate; (2) Gallium 67-citrate; (3) in vitro radiolabeled white blood cell imaging (using 111Indium-oxine or 99mTechnetium hexamethyl-propylene-amine-oxime-labeled white blood cells); and (4) hybrid imaging with 18F-FDG. But children are not just small adults. Not only are the disease processes encountered in children different from those in adults, but there are developmental variants that can mimic, but should not be confused with, pathology. This article discusses some of the differences between adults and children with osteomyelitis, illustrates several of the common developmental variants that can mimic disease, and, finally, focuses on the increasing use of 18F-FDG PET/CT in the diagnosis and response monitoring of children with infectious and inflammatory processes. The value of and need for pediatric specific imaging protocols are reviewed.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA.; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA..
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - A Luana Stanescu
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
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22
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Beaman FD, von Herrmann PF, Kransdorf MJ, Adler RS, Amini B, Appel M, Arnold E, Bernard SA, Greenspan BS, Lee KS, Tuite MJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria ® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot). J Am Coll Radiol 2017; 14:S326-S337. [DOI: 10.1016/j.jacr.2017.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/28/2022]
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23
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FDG-PET imaging to detect and characterize infectious disorders; an unavoidable path for the foreseeable future. Eur J Nucl Med Mol Imaging 2017; 44:417-420. [PMID: 28039496 DOI: 10.1007/s00259-016-3606-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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24
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Abstract
The rise in multidrug resistant (MDR) bacteria has become a global crisis. Rapid and accurate diagnosis of infection will facilitate antibiotic stewardship and preserve our ability to treat and cure patients from bacterial infection. Direct in situ imaging of bacteria offers the prospect of accurately diagnosing disease and monitoring patient outcomes and response to treatment in real-time. There have been many recent advances in the field of optical imaging of infection; namely in specific probe and fluorophore design. This combined with the advances in imaging device technology render direct optical imaging of infection a feasible approach for accurate diagnosis in the clinic. Despite this, there are currently no licensed molecular probes for clinical optical imaging of infection. Here we report some of the most promising and interesting probes and approaches under development for this purpose, which have been evaluated in in vivo models within the laboratory setting.
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25
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Abstract
Radionuclide procedures frequently are performed as part of the diagnostic workup of osteomyelitis. Bone scintigraphy accurately diagnoses osteomyelitis in bones not affected by underlying conditions. Degenerative joint disease, fracture, and orthopedic hardware decrease the specificity of the bone scan, making it less useful in these situations. Gallium-67 scintigraphy was often used as an adjunct to bone scintigraphy for diagnosing osteomyelitis. However, now it is used primarily for spinal infections when (18)F-FDG imaging cannot be performed. Except for the spine, in vitro-labeled leukocyte imaging is the nuclear medicine test of choice for diagnosing complicating osteomyelitis. Leukocytes accumulate in bone marrow as well as in infection. Performing complementary bone marrow imaging with (99m)Tc-sulfur colloid facilitates the differentiation between osteomyelitis and normal marrow and improves test overall accuracy. Antigranulocyte antibodies and antibody fragments, such as (99m)Tc-besilesomab and (99m)Tc-sulesomab, were developed to eliminate the disadvantages associated with in vitro-labeled leukocytes. These agents, however, have their own shortcomings and are not widely available. As biotin is used as a growth factor by certain bacteria, (111)In-biotin is useful to diagnose spinal infections. Radiolabeled synthetic fragments of ubiquicidin, a naturally occurring human antimicrobial peptide that targets bacteria, can differentiate infection from sterile inflammation and may be useful to monitor response to treatment. (18)F-FDG is extremely useful in the diagnostic workup of osteomyelitis. Sensitivity in excess of 95% and specificity ranging from 75%-99% have been reported. (18)F-FDG is the radionuclide test of choice for spinal infection. The test is sensitive, with a high negative predictive value, and reliably differentiates degenerative from infectious vertebral body end-plate abnormalities. Data on the accuracy of (18)F-FDG for diagnosing diabetic pedal osteomyelitis are contradictory, and its role for this indication remains to be determined. Initial investigations suggested that (18)F-FDG accurately diagnoses prosthetic joint infection; more recent data indicate that it cannot differentiate infection from other causes of prosthetic failure. Preliminary data on the PET agents gallium-68 and iodine-124 fialuridine indicate that these agents may have a role in diagnosing osteomyelitis.
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Affiliation(s)
- Christopher J Palestro
- Department of Radiology Hofstra, NorthShore-LIJ School of Medicine, Hempstead, NY; Division of Nuclear Medicine and Molecular Imaging, North Shore Long Island Jewish Health System, Manhasset & New Hyde Park, NY.
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26
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Read C, Branford OA, Verjee LS, Wood SH. PET-CT imaging in patients with chronic sternal wound infections prior to reconstructive surgery: A case series. J Plast Reconstr Aesthet Surg 2015; 68:1132-7. [PMID: 25986418 DOI: 10.1016/j.bjps.2015.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 03/31/2015] [Accepted: 04/26/2015] [Indexed: 11/17/2022]
Abstract
Late presenting and recurrent sternal wound infections post-sternotomy are difficult to treat, with the clinical picture not necessarily reflecting the underlying problem. As a result of our experience, we suggest that these chronic cases should be managed using a different algorithm to acute sternal wound infection. Positron emission tomography combined with computerized tomography (PET-CT) imaging may be potentially useful in enabling accurate localization of disease sites, which guides adequate debridement prior to definitive reconstruction. It may also allow for disease surveillance and monitoring of the response to antimicrobial treatment. We present three cases which support the need for pre-operative imaging using PET-CT.
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Affiliation(s)
- Charlotte Read
- Plastic and Reconstructive Surgery Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Olivier A Branford
- Plastic and Reconstructive Surgery Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Liaquat S Verjee
- Plastic and Reconstructive Surgery Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Simon H Wood
- Plastic and Reconstructive Surgery Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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Mills B, Awais RO, Luckett J, Turton D, Williams P, Perkins AC, Hill PJ. [(18)F]FDG-6-P as a novel in vivo tool for imaging staphylococcal infections. EJNMMI Res 2015; 5:13. [PMID: 25853019 PMCID: PMC4385282 DOI: 10.1186/s13550-015-0095-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/04/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Management of infection is a major clinical problem. Staphylococcus aureus is a Gram-positive bacterium which colonises approximately one third of the adult human population. Staphylococcal infections can be life-threatening and are frequently complicated by multi-antibiotic resistant strains including methicillin-resistant S. aureus (MRSA). Fluorodeoxyglucose ([(18)F]FDG) imaging has been used to identify infection sites; however, it is unable to distinguish between sterile inflammation and bacterial load. We have modified [(18)F]FDG by phosphorylation, producing [(18)F]FDG-6-P to facilitate specific uptake and accumulation by S. aureus through hexose phosphate transporters, which are not present in mammalian cell membranes. This approach leads to the specific uptake of the radiopharmaceutical into the bacteria and not the sites of sterile inflammation. METHODS [(18)F]FDG-6-P was synthesised from [(18)F]FDG. Yield, purity and stability were confirmed by RP-HPLC and iTLC. The specificity of [(18)F]FDG-6-P for the bacterial universal hexose phosphate transporter (UHPT) was confirmed with S. aureus and mammalian cell assays in vitro. Whole body biodistribution and accumulation of [(18)F]FDG-6-P at the sites of bioluminescent staphylococcal infection were established in a murine foreign body infection model. RESULTS In vitro validation assays demonstrated that [(18)F]FDG-6-P was stable and specifically transported into S. aureus but not mammalian cells. [(18)F]FDG-6-P was elevated at the sites of S. aureus infection in vivo compared to uninfected controls; however, the increase in signal was not significant and unexpectedly, the whole-body biodistribution of [(18)F]FDG-6-P was similar to that of [(18)F]FDG. CONCLUSIONS Despite conclusive in vitro validation, [(18)F]FDG-6-P did not behave as predicted in vivo. However at the site of known infection, [(18)F]FDG-6-P levels were elevated compared with uninfected controls, providing a higher signal-to-noise ratio. The bacterial UHPT can transport hexose phosphates other than glucose, and therefore alternative sugars may show differential biodistribution and provide a means for specific bacterial detection.
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Affiliation(s)
- Bethany Mills
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, University Boulevard, Nottingham, NG7 2RD UK
| | - Ramla O Awais
- School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Jeni Luckett
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, University Boulevard, Nottingham, NG7 2RD UK ; School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Dave Turton
- PETNET Solutions, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1 PB UK
| | - Paul Williams
- School of Life Sciences, Centre for Biomolecular Sciences, University of Nottingham, University Boulevard, Nottingham, NG7 2RD UK
| | - Alan C Perkins
- School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Philip J Hill
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, LE12 5RD UK
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28
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Beslic N, Heber D, Walter Lipp R, Sonneck-Koenne C, Knoll P, Mirzaei S. Metabolic Pattern of Asymptomatic Hip-Prosthesis by 18F-FDG-Positron-Emission-Tomography. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e11204. [PMID: 25793083 PMCID: PMC4349100 DOI: 10.5812/iranjradiol.11204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/20/2013] [Accepted: 01/10/2014] [Indexed: 11/16/2022]
Abstract
Background: Joint replacement is a procedure with a major impact on the quality of life of patients with joint degenerative disease or traumatic injuries. However, some patients develop symptoms after the intervention caused by mechanical loosening or infection. Metabolic imaging by 18F-FDG-PET investigated in these patients isoften hampered by low specificity for diagnosis of possible septic vs. mechanical loosening. The reason for this shortcoming is to our opinion the unawareness of physiological remodeling processes that could be seen in asymptomatic patients. Objectives: In order to overcome this drawback, we aimed to find out the physiological metabolic functional pattern in asymptomatic patients with implanted hip prosthesis Patients and Methods: Twelve patients (6 males, 6 females); mean age 73 ± 7 (range 58 - 91) years were prospectively enrolled in the study. The patients were admitted to our department for oncological referral with implanted hip prostheses. All patients explained no symptoms with regard to their implanted prosthesis. The attenuation corrected images were used for analysis. Results: Fourteen hip prostheses in 12 patients were visually analyzed. Seven out of 14 prostheses among 12 patients showed focal periprosthetic enhanced metabolism, two of which showed two sites of enhanced uptake; whereas, the remaining five prostheses showed singular hypermetabolic areas within the periprosthetic site. The remaining seven prostheses in the other five patients showed no periprosthetic-enhanced uptake. Conclusion: Of the asymptomatic patients investigated, 58% showed focal enhanced periprosthetic glucose metabolism. This finding should be taken into consideration as a more probable unspecific metabolic pattern for correct interpretation of 18F-FDG-PET studies in patients with suspected septic loosening of the hip prosthesis.
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Affiliation(s)
- Nermina Beslic
- Department of Nuclear Medicine, Clinical Center University of Sarajevo, Bolnicka, Sarajevo, Bosnia and Herzegovina
| | - Daniel Heber
- Department of Radiology, Medical University of Graz, Austria
| | | | - Charlotte Sonneck-Koenne
- Department of Nuclear Medicine with PET-Center, Wilhelminenspital, Montleart straße 37, 1160 Vienna, Austria
- Corresponding author: Charlotte Sonneck-Koenne, Department of Nuclear Medicine with PET-Center, Wilhelminenspital, Montleart straße 37, 1160 Vienna, Austria. Tel: +43-1491503608, Fax: +43-1491503609, E-mail:
| | - Peter Knoll
- Department of Nuclear Medicine with PET-Center, Wilhelminenspital, Montleart straße 37, 1160 Vienna, Austria
| | - Siroos Mirzaei
- Department of Nuclear Medicine with PET-Center, Wilhelminenspital, Montleart straße 37, 1160 Vienna, Austria
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Asmar A, Ozcan C, Diederichsen ACP, Thomassen A, Gill S. Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis. Eur Heart J Cardiovasc Imaging 2014; 15:1013-9. [PMID: 24711514 DOI: 10.1093/ehjci/jeu054] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the clinical importance of 18F-FDG-PET/CT used in the extra cardiac work-up of patients with infective endocarditis (IE). BACKGROUND IE is a serious condition with a significant mortality. Besides the degree of valvular involvement, the prognosis relies crucially on the presence of systemic infectious embolism. METHODS Seventy-two patients (71% males and mean age 63 ± 17 years) with IE were evaluated with 18F-FDG-PET/CT in addition to standard work-up including patient history, physical examination, conventional imaging modalities, and weekly interdisciplinary conferences. When previous unknown lesions detected by 18F-FDG-PET/CT were confirmed by succeeding examinations, they were considered true positive new findings and were further assessed for their clinical importance. Number needed to investigate was calculated as the number of patients who needed to undergo 18F-FDG-PET/CT to find at least one clinical important true positive new finding, not identified by standard work-up prior to 18F-FDG-PET/CT. RESULTS 18F-FDG-PET/CT detected 114 lesions and 64 were true positive, of which 25 were new findings and detected in 17 patients. In 11 patients, the lesions were considered to have a clinical importance; osteomyelitis (n = 7), iliopsoas abscess (n = 1), gastrointestinal lesions (n = 2), and vascular prosthetic graft (n = 1). Number needed to investigate was 7 (11 of 72 patients). CONCLUSIONS 18F-FDG-PET/CT detected lesions of clinical importance in one of seven IE patients and may be a substantial imaging technique for tracing peripheral infectious embolism due to IE. Thus, 18F-FDG-PET/CT may help to guide adequate therapy and thereby improve the prognosis of patients with IE.
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Affiliation(s)
- Ali Asmar
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Cengiz Ozcan
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Axel C P Diederichsen
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Anders Thomassen
- Department of Nuclear Medicine, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
| | - Sabine Gill
- Department of Cardiology, Odense University Hospital, Sdr Boulevard 29, 5000 Odense C, Denmark
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Tayama E, Hori H, Ueda T, Kono T, Imasaka KI, Harada T, Tomita Y. Usefulness of 18F-FDG-PET/CT in aortic graft infection: two cases. J Cardiothorac Surg 2014; 9:42. [PMID: 24597795 PMCID: PMC3996034 DOI: 10.1186/1749-8090-9-42] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
Diagnosis of vascular graft prosthesis infection is crucial, but not straightforward. Here we report two cases in which [(18)F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) was very useful in the diagnosis of aortic graft infection. Case 1: A 77-year-old Japanese man, two months status post aortic arch graft surgery, suffered from repeated fevers. Blood cultures revealed bacteremia. (18)F-FDG-PET/CT ruled out graft infection and diagnosed lumbar pyogenic spondylitis, which was treated with antibiotics, sparing the patient a possible reoperation. Case 2: A 53-year-old Japanese man, seven years status post replacement of the aortic root and ascending aorta, had been suffering from an ostensibly aseptic fistula for over a year and a half. Although repeated CT findings had been negative, (18)F-FDG-PET/CT clearly demonstrated communication between the fistula and the ascending aortic graft. He was treated with repeat ascending aortic replacement, omentopexy, and antibiotics. Our experience supports (18)F-FDG-PET/CT as a promising modality in cases of suspected vascular graft infection.
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Affiliation(s)
- Eiki Tayama
- Department of Cardiovascular Surgery, Clinical Research Institution, Kyushu Medical Center, National Hospital Organization, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
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Aksoy SY, Asa S, Ozhan M, Ocak M, Sager MS, Erkan ME, Halac M, Kabasakal L, Sönmezoglu K, Kanmaz B. FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection. Eur J Nucl Med Mol Imaging 2013; 41:556-64. [PMID: 24196917 DOI: 10.1007/s00259-013-2597-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/01/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The demand for arthroplasty is rapidly growing as a result of the ageing of the population. Although complications such as heterotrophic ossification, fracture and dislocation are relatively rare, differentiating aseptic loosening, the most common complication of arthroplasty from infection, is a major challenge for clinicians. Radionuclide imaging is currently the imaging modality of choice since it is not affected by orthopaedic hardware. Whereas FDG PET/CT imaging has been widely used in periprosthetic infection, it cannot discriminate aseptic from septic inflammation. In this study we aimed to evaluate the role of FDG PET/CT and FDG-labelled leucocyte PET/CT in the diagnosis of periprosthetic infection. METHODS Of 54 patients with painful joint arthroplasty who were imaged by FDG PET/CT for diagnosis of periprosthetic infection examined, 46 (36 women, 10 men; mean age 61.04 ± 12.2 years, range 32-89 years) with 54 painful joint prostheses (19 hip, 35 knee) with grade 2 (above liver uptake) FDG accumulation on FDG PET/CT were included in the study and these 46 patients also underwent FDG-labelled leucocyte PET/CT. Final diagnoses were made by histopathological-microbiological culture or clinical follow-up. RESULTS The final diagnosis showed infection in 15 (28%) and aseptic loosening in 39 (72%) of the 54 prostheses. FDG PET/CT was found to have a positive predictive value of 28% (15/54). Since patients with no FDG uptake on FDG PET/CT were excluded from the study, the sensitivity, specificity, negative predictive value and accuracy could not be calculated. The sensitivity, specificity, and positive and negative predictive values of FDG-labelled leucocyte PET/CT were 93.3% (14/15), 97.4% (38/39), 93.3% and 97.4%, respectively. CONCLUSION Since FDG is not specific to infection, the specificity of FDG PET/CT was very low. FDG-labelled leucocyte PET/CT with its high specificity may be a useful method and better than labelled leucocyte scintigraphy in periprosthetic infection imaging.
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Affiliation(s)
- Sabire Yılmaz Aksoy
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Aksaray, Istanbul, Turkey,
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Adjtoutah D, Azhari A, Larabi Y, Dorigo E, Merlin C, Marcaggi X, Nana AS, Camilleri L, Azarnoush K. Advantages of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in detecting post cardiac surgery infections. J Saudi Heart Assoc 2013; 26:57-61. [PMID: 24578602 DOI: 10.1016/j.jsha.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/23/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED The 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) offers an excellent negative predictive value. Consequently, it is a reliable tool for excluding an infectious phenomenon in case of negativity. In case of persistent fever of unknown origin after cardiac surgery and in combination with other bacteriological examinations and medical imaging, we can rely on FDG-PET/CT to confirm or eliminate deep infections and prosthetic endocarditis. For this reason, FDG-PET/CT should be considered among the examinations to be performed in case of suspected infection after cardiac surgery. We have reported the case of a 76-year-old man who presented with a fever of unknown origin and recurrent septic shocks after a biological Bentall procedure combined with left anterior descending (LAD) coronary artery revascularization by the left internal thoracic artery. We performed a FDG-PET/CT which showed external iliac vein and right common femoral vein hyperfixation with infiltration of adjacent soft tissues, highly suspected to be an infectious process. LEARNING OBJECTIVE The aim of this case report is to show that FDG-PET/CT, in combination with other bacteriological examinations and medical imaging, can be extremely helpful in detecting deep infectious sources, even during the early postoperative period.
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Affiliation(s)
| | - Alaa Azhari
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Youcef Larabi
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Enrica Dorigo
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Charles Merlin
- Nuclear Medicine Department, Jean Perrin Cancer Center, Clermont-Ferrand
| | | | | | - Lionel Camilleri
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Kasra Azarnoush
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
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(18)F-FDG PET/CT in differentiating acute tuberculous from idiopathic pericarditis: preliminary study. Clin Nucl Med 2013; 38:e160-5. [PMID: 23429393 DOI: 10.1097/rlu.0b013e31827a2537] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate retrospectively the diagnostic capability of F-FDG PET/CT in differentiating acute tuberculous from idiopathic pericarditis. METHODS FDG PET/CT findings were reviewed in 15 patients with acute tuberculous (n = 5) or idiopathic pericarditis (n = 10). The maximal thickness and SUVmax of the pericardium and the number, size, and SUVmax of the mediastinal and supraclavicular lymph nodes with increased FDG uptake were measured. RESULTS All patients had small-to-large amount of pericardial effusion. The patients with acute tuberculous pericarditis (n = 5) showed diffuse (n = 3) or multifocal (n = 2) FDG uptake in the pericardia. The patients with acute idiopathic pericarditis (n = 10) showed diffuse (n = 6) or regional (n = 4) FDG uptake in the pericardia. The mean (SD) pericardial thickness and SUVmax of acute tuberculous pericarditis were significantly higher than those of acute idiopathic pericarditis (5.1 [1.0] vs 3.4 [0.9], P < 0.05; 13.5 [3.9] vs 3.0 [0.7], P < 0.05, respectively). A total of 69 mediastinal and supraclavicular lymph nodes with increased FDG uptake were observed in all 15 patients (44 in patients with acute tuberculous pericarditis and 25 in patients with acute idiopathic pericarditis). The mean (SD) SUVmax of mediastinal and supraclavicular lymph nodes of acute tuberculous pericarditis (5.3 [1.8]) was significantly higher than that of acute idiopathic pericarditis (2.8 [0.6], P < 0.05). There was no significant difference in the mean size of the mediastinal and supraclavicular lymph nodes between acute tuberculous and idiopathic pericarditis. CONCLUSIONS The degrees of FDG uptake in the pericardium and the mediastinal and supraclavicular lymph nodes are useful for differentiating acute tuberculous from idiopathic pericarditis. Familiarity with the FDG uptake patterns of acute tuberculous and idiopathic pericarditis may be helpful for successful (especially timely) diagnosis and treatment.
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FDG PET/CT images demonstrating Fournier gangrene with bilateral pelvic muscle extension in a patient with recurrent rectosigmoid cancer. Clin Nucl Med 2013; 39:52-3. [PMID: 23510891 DOI: 10.1097/rlu.0b013e3182868077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 71-year-old male patient with Parkinsonism was referred for an F-FDG PET/CT scan for suspicious recurrence of rectosigmoid adenocarcinoma. The FDG PET/CT scan revealed increased FDG uptakes in the lower pelvic region around the wall of the rectal stump, with extension to the bilateral pelvic sidewalls and the right gluteous minimus muscle. In addition, multiple small air bubbles were noted in the lesions on the attenuation CT images. Fournier gangrene was diagnosed. After treatment with intravenous antibiotics and debridement with sigmoidoscopic irrigation, the patient was discharged and remained uneventful during clinical follow-up for 50 days.
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36
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The diagnostic protocol for evaluation of periprosthetic joint infection. Hip Int 2013; 22 Suppl 8:S25-35. [PMID: 22956369 DOI: 10.5301/hip.2012.9567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2012] [Indexed: 02/04/2023]
Abstract
Infection is becoming the most important as well as the most devastating mechanism of prosthetic joint failure. The incidence is increasing because the absolute number of patients operated is increasing and because more often very sick, debilitated and immunocompromised patients are operated. The trend reveals a further increase in the years to come. Diagnosis may be very easy in case of high grade processes, but also extremely difficult in some other instances. Misdiagnosing infection leads to repeated early failures that are distressing for patients as well as surgeons. To avoid failures related to misdiagnosed prosthetic joint infections a step-wise algorithm of action is proposed and the diagnostic strength of the steps discussed. The key point is to select potential candidates to define the probability of an ongoing infection and then to select the tools to strengthen the suspicion. Further procedures are based on the analysis of the pseudo-synovial fluid obtained by aspiration. Diagnostic conclusions form the basis for treatment decisions.
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37
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FDG PET imaging for diagnosing prosthetic joint infection: discussing the facts, rectifying the unsupported claims and call for evidence-based and scientific approach. Eur J Nucl Med Mol Imaging 2013; 40:464-6. [DOI: 10.1007/s00259-012-2319-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/10/2012] [Indexed: 11/27/2022]
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Amin R, Charron M, Grinblat L, Shammas A, Grasemann H, Graniel K, Ciet P, Tiddens H, Ratjen F. Cystic fibrosis: detecting changes in airway inflammation with FDG PET/CT. Radiology 2012; 264:868-75. [PMID: 22829680 DOI: 10.1148/radiol.12111873] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine if fluorine 18 fluorodeoxyglucose (FDG) positron emission tomographic (PET)/computed tomographic (CT) imaging can depict a treatment effect from intravenous antibiotics for pulmonary exacerbation in cystic fibrosis (CF). MATERIALS AND METHODS The study was approved by the institutional review board of the Hospital for Sick Children and by Health Canada. Consent was obtained from all subjects. Patients with CF who were between 6 and 18 years of age and were admitted for a pulmonary exacerbation were eligible for the study. FDG PET/CT examinations (with low-dose CT) were performed on days 1 and 14 of admission (±72 hours). PET activity was quantified by using standardized uptake values (SUVs) through assessment of background activity (mean SUV [SUV(mean)]) and superimposed focal uptake (maximum SUV [SUV(max)]) for each lung zone. CT studies were scored by using the CF-CT model. SUVs from pre- and posttherapy studies were compared by using paired t tests. Unpaired t tests were used to compare data in patients with CF and data in 10 control subjects. RESULTS Twenty patients with CF were enrolled. Antibiotic therapy resulted in a significant decrease in SUV(max) (mean difference, 2.3 ± 2.1 [standard deviation], P < .0001). Pretherapy SUV(max) and SUV(mean) and posttherapy SUV(max) were significantly different from those in control subjects. The change in SUV(max) and percentage predicted forced expiratory volume in 1 second was negatively correlated. (R = -0.72, P = .004). Overall CF-CT scores significantly correlated with SUV(max) (R = 0.40, P = .01). CONCLUSION FDG PET/CT is a useful tool for detecting inflammatory changes resulting from treatment for pulmonary exacerbations in pediatric patients with CF. Inflammatory changes detected by using FDG PET/CT correlated with lung function, sputum neutrophil counts, and CF-CT scores. Analyzing focal lung inflammation (with SUV(max)) may be a feasible way to measure airway inflammation in patients with CF.
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Affiliation(s)
- Reshma Amin
- Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada.
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Saboury B, Ziai P, Parsons M, Zhuang H, Basu S, Alavi A. Promising Roles of PET in Management of Arthroplasty-Associated Infection. PET Clin 2012; 7:139-50. [PMID: 27157232 DOI: 10.1016/j.cpet.2012.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A number of diagnostic tests is often necessary to differentiate aseptic loosening from periprosthetic infection in most clinical settings. The accuracy of [(18)F]Fluorodeoxyglucose examined with positron emission tomography imaging (FDG PET) in diagnosing periprosthetic infection has been determined by a number of investigations. In general, Images are considered positive for infection if they demonstrate increased FDG activity at the bone-prosthesis interface of the prostheses. Based on the large number of reports in the literature the sensitivity and specificity for FDG PET are about 85-90%. The overall accuracy of this non-invasive imaging modality is superior to the other existing imaging techniques. Therefore, FDG PET appears a very promising and accurate diagnosing tool for distinguishing septic from aseptic painful hip prostheses.
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Affiliation(s)
- Babak Saboury
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Pouya Ziai
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Molly Parsons
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Hongming Zhuang
- Division of Nuclear Medicine, Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Parel, Bombay 400012, India
| | - Abass Alavi
- Department of Radiology, School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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40
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Xu B, Liu Y, Codreanu I. Utilization of FDG PET/CT in the Management of Inflammation and Infection in Patients with Malignancies. PET Clin 2012; 7:211-8. [DOI: 10.1016/j.cpet.2012.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Merhej V, Cammilleri S, Piquet P, Casalta JP, Raoult D. Relevance of the positron emission tomography in the diagnosis of vascular graft infection with Coxiella burnetii. Comp Immunol Microbiol Infect Dis 2012; 35:45-9. [DOI: 10.1016/j.cimid.2011.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/29/2011] [Accepted: 09/29/2011] [Indexed: 10/15/2022]
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42
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Jacovides CL, Parvizi J, Adeli B, Jung KA. Molecular markers for diagnosis of periprosthetic joint infection. J Arthroplasty 2011; 26:99-103.e1. [PMID: 21570803 DOI: 10.1016/j.arth.2011.03.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/11/2011] [Indexed: 02/01/2023] Open
Abstract
Despite a battery of tests available for diagnosing periprosthetic joint infection, as yet, no gold standard has been identified. Our purpose was to measure inflammatory proteins in synovial fluid from patients undergoing revision arthroplasty for septic or aseptic failure. We analyzed 74 synovial fluid samples: 31 infected and 43 uninfected, based on clinical and laboratory criteria. Proteomics analysis and receiver operating characteristic curve analyses were conducted on 46 inflammatory proteins for each sample. Of 46 proteins, 5 (interleukin 6, interleukin 8, α(2)-macroglobulin, C-reactive protein, and vascular endothelial growth factor) had an area under the curve greater than 0.90. This prospective study has demonstrated promising results for the use of molecular markers in diagnosis of periprosthetic joint infection. Future studies will focus on designing assays with these proteins in mind.
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Affiliation(s)
- Christina L Jacovides
- Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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Functional imaging of infection: conventional nuclear medicine agents and the expanding role of 18-F-FDG PET. Pediatr Radiol 2011; 41:803-10. [PMID: 21607605 DOI: 10.1007/s00247-011-2013-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
Abstract
A growing body of literature suggests that 18-fluorine fluorodeoxyglucose positron emission tomography ((18)F-FDG PET), particularly when combined with CT, is a useful tool for the detection of infectious and inflammatory disease processes. This article will briefly review the data to date on the use of FDG PET in diagnosing musculoskeletal infections and fever of unknown origin, comparing it to conventional scintigraphic techniques in both adults and, when available, in children.
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Bleeker-Rovers CP, Vos FJ, van der Graaf WTA, Oyen WJG. Nuclear medicine imaging of infection in cancer patients (with emphasis on FDG-PET). Oncologist 2011; 16:980-91. [PMID: 21680576 DOI: 10.1634/theoncologist.2010-0421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infections are a common cause of death and an even more common cause of morbidity in cancer patients. Timely and adequate diagnosis of infection is very important. This article provides clinicians as well as nuclear medicine specialists with a concise summary of the most important and widely available nuclear medicine imaging techniques for infectious and inflammatory diseases in cancer patients with an emphasis on fluorodeoxyglucose positron emission tomography (FDG-PET). ⁶⁷Ga-citrate has many unfavorable characteristics, and the development of newer radiopharmaceuticals has resulted in the replacement of ⁶⁷Ga-citrate scintigraphy by scintigraphy with labeled leukocytes or FDG-PET for the majority of conditions. The sensitivity of labeled leukocyte scintigraphy in non-neutropenic cancer patients is comparable with that in patients without malignancy. The specificity, however, is lower because of the uptake of labeled leukocytes in many primary tumors and metastases, most probably as a result of their inflammatory component. In addition, labeled leukocyte scintigraphy cannot be used for febrile neutropenia because of the inability to harvest sufficient peripheral leukocytes for in vitro labeling. FDG-PET has several advantages over these conventional scintigraphic techniques. FDG-PET has shown its usefulness in diagnosing septic thrombophlebitis in cancer patients. It has also been shown that imaging of infectious processes using FDG-PET is possible in patients with severe neutropenia. Although larger prospective studies examining the value of FDG-PET in cancer patients suspected of infection, especially in those with febrile neutropenia, are needed, FDG-PET appears to be the most promising scintigraphic technique for the diagnosis of infection in this patient group.
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Signore A, Mather SJ, Piaggio G, Malviya G, Dierckx RA. Molecular imaging of inflammation/infection: nuclear medicine and optical imaging agents and methods. Chem Rev 2010; 110:3112-45. [PMID: 20415479 DOI: 10.1021/cr900351r] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- A Signore
- Nuclear Medicine Unit, II Faculty of Medicine and Surgery, Sapienza University of Rome, Rome, Italy.
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Plebani M. Biochemical and imaging biomarkers: the search for the Holy Grail. Clin Chem Lab Med 2010; 48:1055-1056. [DOI: 10.1515/cclm.2010.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University-Hospital, Padova, Via Giustiniani 2, 35128 Padova, and Leonardo Foundation, Abano Terme General Hospital, Italy
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48
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Cheng G, Fosse P, Zhuang H, Hustinx R. Applications of PET and PET/CT in the Evaluation of Infection and Inflammation in the Skeletal System. PET Clin 2010; 5:375-85. [DOI: 10.1016/j.cpet.2010.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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van der Bruggen W, Bleeker-Rovers CP, Boerman OC, Gotthardt M, Oyen WJG. PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review. Semin Nucl Med 2010; 40:3-15. [PMID: 19958846 DOI: 10.1053/j.semnuclmed.2009.08.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review the literature on diagnostic accuracy and clinical value of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) for imaging of bone and joint infections. METHODS The PubMed/MEDLINE and Embase (OvidSP) literature databases were systematically searched for publications on SPECT and PET on osteomyelitis and prosthetic bone and joint infections using specific guidelines with MeSH-terms, truncations, and completion using cross-references. RESULTS In 44 original articles (15 for SPECT and 29 for (18)F-fluorodeoxyglucose [FDG]-PET) on osteomyelitis and prosthetic bone and joint infection, 1634 patients were included (580 patients SPECT, 1054 patients FDG-PET). Level of evidence (Oxford criteria) was 2-3b. For SPECT, the highest diagnostic accuracy of 95% for diagnosis of bone and joint infections is achieved with combined (111)In-WBC and (99m)Tc-sulfur colloid. Acceptable diagnostic accuracy was also obtained with (99m)Tc-WBC or (111)In-WBC combined with (99m)Tc-methylene diphosphonate ((99m)Tc-MDP). FDG-PET is useful for diagnosis of osteomyelitis with a sensitivity and specificity generally over 95%. In patients with orthopedic implant infections, sensitivity varies widely from 28% to 91% and specificity from 9% to 97%. This variation in FDG-PET performance in orthopedic implant infections depends largely on the (use of different) criteria to diagnose infection. Determination of the best criteria is still a matter of debate. CONCLUSIONS SPECT/computed tomography (CT) with (111)In-WBC combined with (99m)Tc-MDP or (99m)Tc-sulfur colloid seems to be the best imaging technique for diagnosis of bone and joint infections. FDG-PET is also useful for diagnosis of osteomyelitis with improved spatial resolution over SPECT imaging, allowing more accurate localization. Localization can be further improved by adding CT. Diagnosis of orthopedic implant infections with FDG-PET depends strongly on the localization of the implant and the criteria used to diagnose infection. Confirmation of well defined criteria to diagnose infection on FDG-PET in patients with metallic implants is thus of paramount importance for optimal diagnosis.
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Affiliation(s)
- Wouter van der Bruggen
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Gemmel F, Rijk PC, Collins JMP, Parlevliet T, Stumpe KD, Palestro CJ. Expanding role of 18F-fluoro-D-deoxyglucose PET and PET/CT in spinal infections. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:540-51. [PMID: 20052505 DOI: 10.1007/s00586-009-1251-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 11/10/2009] [Accepted: 12/10/2009] [Indexed: 12/19/2022]
Abstract
(18)F-fluoro-D -deoxyglucose positron emission tomography ([(18)F]-FDG PET) is successfully employed as a molecular imaging technique in oncology, and has become a promising imaging modality in the field of infection. The non-invasive diagnosis of spinal infections (SI) has been a challenge for physicians for many years. Morphological imaging modalities such as conventional radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are techniques frequently used in patients with SI. However, these methods are sometimes non-specific, and difficulties in differentiating infectious from degenerative end-plate abnormalities or postoperative changes can occur. Moreover, in contrast to CT and MRI, FDG uptake in PET is not hampered by metallic implant-associated artifacts. Conventional radionuclide imaging tests, such as bone scintigraphy, labeled leukocyte, and gallium scanning, suffer from relatively poor spatial resolution and lack sensitivity, specificity, or both. Initial data show that [(18)F]-FDG PET is an emerging imaging technique for diagnosing SI. [(18)F]-FDG PET appears to be especially helpful in those cases in which MRI cannot be performed or is non-diagnostic, and as an adjunct in patients in whom the diagnosis is inconclusive. The article reviews the currently available literature on [(18)F]-FDG PET and PET/CT in the diagnosis of SI.
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Affiliation(s)
- Filip Gemmel
- Department of Nuclear Medicine, KCL, Medical Center Leeuwarden, Borniastraat 34, 8934 AD Leeuwarden, The Netherlands.
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