Love Charito, Marwin Scott E, Tomas Maria B, Krauss Eugene S, Tronco Gene G, Bhargava Kuldeep K, Nichols Kenneth J, Palestro Christopher J
Division of Nuclear Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
J Nucl Med. 2004 Nov;45(11):1864-71.
The objectives of this study were to investigate (18)F-FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements.
Fifty-nine patients--with painful, failed, lower extremity joint prostheses, 40 hip and 19 knee--who underwent (18)F-FDG, labeled leukocyte, and bone marrow imaging, and had histopathologic and microbiologic confirmation of the final diagnosis, formed the basis of this investigation. (18)F-FDG images were interpreted as positive for infection using 4 different criteria: criterion 1: any periprosthetic activity, regardless of location or intensity; criterion 2: periprosthetic activity on the (18)F-FDG image, without corresponding activity on the marrow image; criterion 3: only bone-prosthesis interface activity, regardless of intensity; criterion 4: semiquantitative analysis--a lesion-to-background ratio was generated, and the cutoff value yielding the highest accuracy for determining the presence of infection was determined. Labeled leukocyte/marrow images were interpreted as positive for infection when periprosthetic activity was present on the labeled leukocyte image without corresponding activity on the marrow image.
Twenty-five (42%) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of (18)F-FDG, by criterion, were as follows: criterion 1: 100%, 9%, 47%; criterion 2: 96%, 35%, 61%; criterion 3: 52%, 44%, 47%; criterion 4: 36%, 97%, 71%. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100%, 91%, and 95%, respectively. WBC/marrow imaging, which was more accurate than any of the (18)F-FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P < 0.001) and criterion 4 (P < 0.001) and was significantly more specific than criterion 1 (P < 0.001), criterion 2 (P < 0.001), and criterion 3 (P < 0.001).
Regardless of how the images are interpreted, coincidence detection-based (18)F-FDG imaging is less accurate than, and cannot replace, labeled leukocyte/marrow imaging for diagnosing infection of the failed prosthetic joint.
本研究的目的是使用符合探测系统研究（18）F-FDG成像诊断人工关节感染，并将其与下肢关节置换失败患者的联合（111）In标记白细胞/（99m）Tc硫胶体骨髓成像进行比较。
59例下肢关节假体疼痛且置换失败的患者，其中40例为髋关节，19例为膝关节，接受了（18）F-FDG、标记白细胞和骨髓成像，并经组织病理学和微生物学确诊最终诊断，构成了本研究的基础。（18）F-FDG图像根据4种不同标准被解释为感染阳性：标准1：假体周围任何活性，无论位置或强度；标准2：（18）F-FDG图像上的假体周围活性，骨髓图像上无相应活性；标准3：仅骨-假体界面活性，无论强度；标准4：半定量分析——生成病变与背景比值，并确定对确定感染存在具有最高准确性的临界值。当标记白细胞图像上存在假体周围活性而骨髓图像上无相应活性时，标记白细胞/骨髓图像被解释为感染阳性。
25个（42%）假体，14个髋关节和11个膝关节，被感染。（18）F-FDG根据标准的敏感性、特异性和准确性如下：标准1：100%，9%，47%；标准2：96%，35%，61%；标准3：52%，44%，47%；标准4：36%，97%，71%。标记白细胞/骨髓成像的敏感性、特异性和准确性分别为100%、91%和95%。白细胞/骨髓成像在所有假体以及分别在髋关节和膝关节方面比任何（18）F-FDG标准更准确，比标准3（P<0.001）和标准4（P<0.001）显著更敏感，比标准1（P<0.001）、标准2（P<0.001）和标准3（P<0.001）显著更具特异性。
无论图像如何解释，基于符合探测的（18）F-FDG成像在诊断失败人工关节感染方面不如标记白细胞/骨髓成像准确，且不能替代它。
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