Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K
Department of Nuclear Medicine, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Germany.
Nucl Med Commun. 2002 Jul;23(7):645-53. doi: 10.1097/00006231-200207000-00009.
Pain is a common unspecific symptom in orthopaedic prosthetics. The accurate differentiation between synovitis, loosening or infection is often difficult with conventional X-rays, arthrography or bone scintigraphy. Because of the high glucose uptake of inflammatory cells, [18F]fluorodeoxyglucose (18F-FDG) is an appropriate tracer for the evaluation of suspected inflammation or infection. In this preliminary study we describe 18F-FDG PET findings in patients referred for evaluation of painful hip or knee prostheses. We studied 23 patients with 28 prostheses, 14 hip and 14 knee prostheses, who had a complete operative or clinical follow-up. 18F-FDG PET scans were obtained with an ECAT EXACT HR+ PET scanner. High glucose uptake in the bone prostheses interface was considered as positive for infection, an intermediate uptake as suspect for loosening, and uptake only in the synovia was considered as synovitis. The imaging results were compared with operative findings or clinical outcome. PET correctly identified three hip and one knee prostheses as infected, two hip and two knee prostheses as loosening, four hip and nine knee prostheses as synovitis, and two hip and one knee prostheses as unsuspected for loosening or infection. In three patients covered with an expander after explantation of an infected prosthesis PET revealed no further evidence of infection in concordance with the clinical follow-up. PET was false negative for loosening in one case. Our preliminary results suggest that FDG PET could be a useful tool for differentiating between infected and loose orthopaedic prostheses as well as for detecting only inflammatory tissue such as synovitis.
疼痛是骨科假体中常见的非特异性症状。使用传统的X线、关节造影或骨闪烁显像术往往难以准确区分滑膜炎、松动或感染。由于炎症细胞对葡萄糖摄取率高，[18F]氟脱氧葡萄糖（18F-FDG）是评估疑似炎症或感染的合适示踪剂。在这项初步研究中，我们描述了因髋或膝关节假体疼痛而接受评估的患者的18F-FDG PET检查结果。我们研究了23例患者的28个假体，其中14个髋关节假体和14个膝关节假体，这些患者均有完整的手术或临床随访资料。使用ECAT EXACT HR+PET扫描仪进行18F-FDG PET扫描。骨假体界面处的高葡萄糖摄取被认为感染呈阳性，中等摄取被怀疑为松动，仅滑膜处有摄取被认为是滑膜炎。将影像结果与手术所见或临床结果进行比较。PET正确识别出3个髋关节假体和1个膝关节假体感染，2个髋关节假体和2个膝关节假体松动，4个髋关节假体和9个膝关节假体滑膜炎以及2个髋关节假体和1个膝关节假体无松动或感染迹象。在3例感染假体取出后用扩张器覆盖的患者中，PET显示与临床随访一致，无进一步感染证据。PET对1例松动病例呈假阴性。我们的初步结果表明，FDG PET可能是区分感染性和松动性骨科假体以及仅检测滑膜炎等炎症组织的有用工具。
