Stumpe Katrin D M, Romero Jose, Ziegler Oliver, Kamel Ehab M, von Schulthess Gustav K, Strobel Klaus, Hodler Juerg
Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, Zurich, Switzerland.
Eur J Nucl Med Mol Imaging. 2006 Oct;33(10):1218-25. doi: 10.1007/s00259-006-0127-1. Epub 2006 May 24.
The purpose of this study was to evaluate 18F-fluorodeoxyglucose (FDG) uptake in patients with painful total knee arthroplasty and to relate FDG uptake to the location of soft tissue pain.
Twenty-eight patients with painful total knee arthroplasty had a clinical examination, standard radiographs, CT measurement of rotation of the femoral component and FDG-PET (18 PET/CT, 10 PET). The diagnosis of infection was based on microbiological examinations of surgical specimens (n=12) or clinical follow-up for at least 6 months (n=16), 99mTc-labelled monoclonal antibody scintigraphy and joint aspiration.
Twenty-seven of 28 patients presented with diffuse synovial FDG uptake. Additional focal extrasynovial FDG uptake was observed in 19 knees. Twenty-four of the 28 patients had a diagnosis of internal femoral malrotation. The remaining four patients showed no rotation (0 degrees) and 3 degrees, 4 degrees and 7 degrees of external rotation, respectively. Three patients presented with the additional diagnosis of an infected total knee replacement. Pain was described as diffuse (n=10) or focal (n=18). In two knees a relationship between pain location and FDG uptake was observed. Of ten patients with a severe internal femoral component rotation (>6 degrees), seven had focal uptake, four in the femoral periosteum and three in the tibial periosteum. The difference between knees with severe malrotation and the remaining knees was not significant (p=1.000, Fisher's Exact Test).
Diffuse synovial and focal extrasynovial FDG-PET uptake is commonly found in patients with malrotation of the femoral component and is not related to pain location. The information provided by FDG-PET does not contribute to the diagnosis and management of individual patients with persistent pain after total knee replacement.
本研究旨在评估全膝关节置换术后疼痛患者的18F-氟脱氧葡萄糖（FDG）摄取情况，并将FDG摄取与软组织疼痛部位相关联。
28例全膝关节置换术后疼痛患者接受了临床检查、标准X线片、股骨组件旋转的CT测量以及FDG-PET（18例PET/CT，10例PET）检查。感染的诊断基于手术标本的微生物学检查（n = 12）或至少6个月的临床随访（n = 16）、99mTc标记的单克隆抗体闪烁扫描和关节穿刺。
28例患者中有27例出现弥漫性滑膜FDG摄取。在19个膝关节中观察到额外的局灶性滑膜外FDG摄取。28例患者中有24例诊断为股骨内旋异常。其余4例患者分别显示无旋转（0度）以及3度、4度和7度的外旋。3例患者还被诊断为全膝关节置换感染。疼痛被描述为弥漫性（n = 10）或局灶性（n = 18）。在两个膝关节中观察到疼痛部位与FDG摄取之间的关系。在10例股骨组件严重内旋（>6度）的患者中，7例有局灶性摄取，4例在股骨骨膜，3例在胫骨骨膜。严重旋转异常的膝关节与其余膝关节之间的差异无统计学意义（p = 1.000，Fisher精确检验）。
在股骨组件旋转异常的患者中常见弥漫性滑膜和局灶性滑膜外FDG-PET摄取，且与疼痛部位无关。FDG-PET提供的信息对全膝关节置换术后持续疼痛的个体患者的诊断和管理没有帮助。
