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Puijk R, Lubbe P, Sierevelt IN, Kristians AE, Boer J, Nolte PA. The Diagnostic Characteristic and Reproducibility of Bone Scintigraphy Single-Photon Emission Computed Tomography/Computed Tomography for Diagnosing Aseptic Loosening of Uncemented Total Knee Arthroplasty. J Arthroplasty 2024; 39:1707-1713.e1. [PMID: 38218556 DOI: 10.1016/j.arth.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The primary objective of this study was to investigate the diagnostic characteristics of bone scintigraphy single-photon emission computed tomography/computed tomography (BS-SPECT/CT) for diagnosing aseptic loosening after uncemented total knee arthroplasty (TKA), and to evaluate the following aspects: how to manage inconclusive results, the interobserver reliability, and the location of tracer uptake between symptomatic cases with and without aseptic loosening. METHODS In this study, 180 patients who had uncemented TKA and persistent knee pain suspected of aseptic loosening were included. As part of routine medical care, BS-SPECT/CT was used, and its results were compared with the reference standard, which involved revision surgery for aseptic loosening or a 12-month follow-up without revision or imaging. Inconclusive BS-SPECT/CT results were considered either negative (best-case scenario) or positive (worst-case scenario). Sensitivity, specificity, positive/negative likelihood ratios (LRs), and positive/negative predictive values (PPV and NPV) were calculated. Sensitivity analyses were conducted by comparing the diagnostic characteristics between cases with a follow-up of less and more than 2 years of follow-up. The anatomical distribution of tracer uptake and interobserver reliability were also evaluated. RESULTS Of the 180 BS-SPECT/CT scans conducted, 22 were determined positive, 113 negative, and 45 inconclusive. The best-case scenario showed a sensitivity of 66.7%, specificity of 93.8%, +LR 10.8, -LR 0.4, PPV 54.6%, and NPV 96.2%. In contrast, the worst-case scenario had a sensitivity of 94.4%, specificity of 69.1%, +LR 3.1, -LR 0.1, PPV 25.4%, and NPV 99.1%. Sensitivity analyses revealed no relevant differences in characteristics between the 2 TKA-interval groups. The interobserver reliability was fair-to-moderate (κ = 0.39; 95% confidence interval 0.18 to 0.60), with an estimated agreement of 79% (95% confidence interval 70 to 87). Four prosthetic zones had a notably higher proportion of cases with tracer uptake in those with aseptic loosening compared to those without. CONCLUSIONS The test characteristics of BS-SPECT/CT were deemed appropriate in patients who have complaints of uncemented TKA suspected of aseptic loosening. Inconclusive cases were best categorized as negative, especially in patients who have a short interval between TKA and the first BS-SPECT/CT. Increased tracer uptake in 4 prosthetic zones was observed in cases of aseptic loosening, although interobserver reliability was fair to moderate. LEVEL OF EVIDENCE Level III, Diagnostic Retrospective Cohort Study.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Pieter Lubbe
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands; Orthopedic Department, Xpert Clinics, Amsterdam, The Netherlands
| | - Angela E Kristians
- Department of Medical Nuclear Imaging, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Jouke Boer
- Department of Medical Nuclear Imaging, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands; Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Wang Y, Wang R, Zhang X, Li L, Liu H, Chang Y, Li Q, Wang Y, Qi E, Hao L, Chai W, Yao S, Shi Y, Yan W, Shao W, Zhang J, Chen J, Tian J. Diagnostic efficiency of [68 Ga]Ga-DOTA-FAPI-04 in differentiating periprosthetic hip joint infection and aseptic failure. Eur J Nucl Med Mol Imaging 2023; 50:1919-1928. [PMID: 36813979 DOI: 10.1007/s00259-023-06146-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To assess the efficiency of [68 Ga]Ga-DOTA-FAPI-04 in diagnosing periprosthetic hip joint infection and establish a diagnostic standard of clinical significance based on uptake pattern. METHODS [68 Ga]Ga-DOTA-FAPI-04 PET/CT was performed in patients with symptomatic hip arthroplasty from December 2019 to July 2022. The reference standard was based on the 2018 Evidence-Based and Validation Criteria. Two diagnostic criteria, SUVmax and uptake pattern, were used to diagnose PJI. Meanwhile, original data were imported into IKT-snap to draw the view of interest, A.K. was used to extract features of clinical cases, and unsupervised clustering analysis was applied according to the groups. RESULTS A total of 103 patients were included, 28 of whom had PJI. The area under the curve of SUVmax was 0.898, which was better than that of all of the serological tests. The cutoff value of SUVmax was 7.53, and the sensitivity and specificity were 100 and 72%, respectively. The sensitivity, specificity and accuracy of the uptake pattern were 100, 93.1 and 95%, respectively. In radiomics analysis, the features of PJI were significantly different from those of aseptic failure. CONCLUSION The efficiency of [68 Ga]Ga-DOTA-FAPI-04 PET/CT in diagnosing PJI showed promising results, and the diagnostic criteria of the uptake pattern were more clinically instructive. Radiomics also showed certain application prospects in the field of PJI. TRIAL REGISTRATION NUMBER Trial registration: ChiCTR2000041204. Registered 24 September 2019.
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Affiliation(s)
- Yiqun Wang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Ruimin Wang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Xiaojun Zhang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - La Li
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Beijing, People's Republic of China
| | - Honghong Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Yan Chang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Qingxiao Li
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Yanmei Wang
- General Electric (GE) Healthcare China, Shanghai, People's Republic of China
| | - Erpeng Qi
- Department of Interventional Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Libo Hao
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Department of Orthopedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Chai
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Department of Orthopedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shulin Yao
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Yuanyuan Shi
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Beijing, People's Republic of China
| | - Wenqiang Yan
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, Beijing, People's Republic of China
| | - Wuguo Shao
- Fangshan District, HighTech Atom Co., Ltd, No. 1 Sanqiang Road, Xinzhen, Beijing, People's Republic of China
- China Isotope & Radiation Corporation, Haidian District, No. 66 Changwa Zhongjie, Beijing, People's Republic of China
| | - Jinming Zhang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China.
| | - Jiying Chen
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Department of Orthopedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
| | - Jiahe Tian
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China.
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Palestro CJ. Molecular Imaging of Periprosthetic Joint Infections. Semin Nucl Med 2023; 53:167-174. [PMID: 36496268 DOI: 10.1053/j.semnuclmed.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Infection is an infrequent complication of lower extremity prosthetic joint surgery. Approximately one third develop within 3 months (early), another third within 1 year (delayed), and the remainder more than 1 year (late) after surgery. The diagnosis of periprosthetic joint infection is not always straightforward. Pain, the most common symptom, is present in 90%-100% of patients. The presence of fever is more variable, ranging from less than 5% to more than 40% of patients with infection. Erythema and joint swelling are often present in acute infections, but are less common in chronic infections. Erythrocyte sedimentation rate, C-reactive protein and interleukin-6 levels are useful "rule out" tests, while peripheral blood leukocyte count and serum tumor necrosis factor α are not helpful. The diagnosis of periprosthetic joint infection often requires a combination of blood, synovial fluid, and tissue sample tests, as well as imaging. Plain radiographs lack sensitivity and specificity. Molecular imaging is useful for evaluating painful joint replacements. Bone scintigraphy is most useful as a screening test. If it is negative then infection and aseptic loosening are unlikely. Combined labeled leukocyte/bone marrow imaging is a very specific test for diagnosing lower extremity joint arthroplasty infection; sensitivity is more variable. Despite more than two decades of investigation, there still is no consensus on the value of 18F-FDG for diagnosing periprosthetic joint infection. Differing test probabilities, an inability to discriminate between infection and inflammation secondary to physiologic reactions, and lack of standardized interpretative criteria are obstacles to incorporating 18F-FDG into the routine diagnostic imaging workup of periprosthetic joint infection. Preliminary results for gallium-68 citrate, fluorine-18, and technetium-99m labeled antimicrobial fragments are encouraging but no large scale trials with these agents have been conducted. Limited data suggest that labeled leukocyte/bone marrow SPECT/CT and 18F-FDG-PET/CT are specific but not sensitive for diagnosing periprosthetic infection of shoulder arthroplasties. There are minimal data on molecular imaging for monitoring treatment response in periprosthetic infections.
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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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Srivastava MK, Kendarla VK, Reddy G, Nallapareddy K. Bone Scan: Indications Revisited. Indian J Nucl Med 2023; 38:34-40. [PMID: 37180192 PMCID: PMC10171756 DOI: 10.4103/ijnm.ijnm_174_22] [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: 10/27/2022] [Accepted: 12/24/2022] [Indexed: 02/25/2023] Open
Abstract
Skeletal scintigraphy is one of the most widely performed investigations in any nuclear medicine department. However, there has been a paradigm shift in the indications for which bone scan was performed in the past 3 decades, mainly due to advancement in other imaging modalities, better disease understanding, and the development of newer disease-specific guidelines. The metastatic indications for bone scans accounted for 60.3% of cases in 1998 which reduced to 15.5% in 2021 and nonmetastatic indications rose from 39.7% in 1998 to 84.5% in 2021. Fewer bone scans are being performed for the metastatic survey, and more scans are being performed for nononcological orthopedic and rheumatological indications. This article captures the journey of skeletal scintigraphy in the past three decades.
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Affiliation(s)
| | | | - Geetanjali Reddy
- Department of Nuclear Medicine, NIMS, Hyderabad, Telangana, India
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Abstract
BACKGROUND Aseptic loosening is one of the most common reasons for revision in knee arthroplasty. Its pathogenesis is multifactorial, and early diagnosis is necessary to initiate appropriate therapy and to avoid serious complications, such as substantial bone loss or even periprosthetic fractures. OBJECTIVES This paper describes the current standard in the diagnosis of aseptic loosening in total knee arthroplasty. Sensitivity and specificity of the individual diagnostic procedures are presented, and other causes for differential diagnoses of painful total knee arthroplasty (TKA) are discussed. RESULTS In the case of suspected loosening in TKA, infection diagnostics should be performed to rule out periprosthetic infection, as this is crucial in terms of surgical strategy. The gold standard in diagnosing aseptic loosening is conventional radiography. Radiolucent lines at the cement-bone or metal-cement interface of more than 2 mm or increasing in translucency, migration of components, and cement fractures are obvious signs of loosening. Artifact-reduced computed tomography can bring additional information regarding periprosthetic osteolysis. A single bone scan is not reliable in diagnosing aseptic loosening, especially in the first 2 years after surgery. Single photon emission computed tomography (SPECT-CT) could be a useful extension in loosening diagnosis in the future. CONCLUSIONS The diagnosis of aseptic loosening poses a great challenge to the treating physician and requires a structured diagnostic algorithm. After exclusion of infection, conventional radiography is the basic examination, which should be supplemented by computed tomography and nuclear medicine examinations according to the clinical symptoms and the time course.
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Impact on Blood Tests of Lower Limb Joint Replacement for the Treatment of Osteoarthritis. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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