Sterner T, Pink R, Freudenberg L, Jentzen T, Quitmann H, Bockisch A, Löer F
Department of Orthopaedic Surgery, University of Duisburg-Essen, Essen, Germany.
Int J Surg. 2007 Apr;5(2):99-104. doi: 10.1016/j.ijsu.2006.05.002. Epub 2006 Jun 9.
Total knee arthroplasty is successful in the treatment of degenerative, arthritic or injured joints. But the most important long term complication seems to be aseptic loosening. An inflammatory process at the bone/cement or bone/prosthesis interface leads to a severe osteolysis. Although early diagnosis is very important the standard techniques often fail. [(18)F]Fluoride ion positron emission tomography (F-PET) is an appropriate tracer paired with a modern method for the evaluation of increased bone metabolism at the bone/prosthesis interface. In this preliminary study we describe for the first time the value of F-PET in the early diagnosis of aseptic loosening. We studied 14 painful knee arthoplasties. In 6 cases the definite diagnosis was determined by surgical procedure, for 8 cases a long clinical follow-up of the least 6 months after the onset of symptoms led to the diagnosis. The F-PET scans were obtained by with an ECAT EXACT HR+ scanner with and without attenuation correction in the two-and three-dimensional mode. An intermediate or high uptake along the bone/prosthesis or bone/cement interface including either the tibial stem or the half of the femoral component was suspected to be aseptic loose. The result were compared with plain radiographs. We found a sensitivity of 100%, a specificity of 56% and an accuracy of 71%. No false negative results were detected, in 4 patients one component as false positive. The sensitivity, specificity and accuracy for the plain radiograph of the same patients were 43%, 86% and 64%, respectively. In conclusion PET seems to be a promising new method in the early diagnosis of painful TKA because of its excellent spatial solution. In combination with the bone seeking tracer [(18) F]fluoride, PET allows the detection of aseptic loosening and the differentiation to the simple synovitis. Our preliminary results suggest that F-PET could be a useful tool although we examined a small group of patients.
全膝关节置换术在治疗退行性、关节炎性或受伤关节方面是成功的。但最重要的长期并发症似乎是无菌性松动。骨/骨水泥或骨/假体界面处的炎症过程会导致严重的骨质溶解。尽管早期诊断非常重要，但标准技术常常失效。[（18）F]氟离子正电子发射断层扫描（F-PET）是一种合适的示踪剂，与一种用于评估骨/假体界面处骨代谢增加的现代方法相结合。在这项初步研究中，我们首次描述了F-PET在无菌性松动早期诊断中的价值。我们研究了14例疼痛性膝关节置换术。6例通过手术确定了明确诊断，8例在症状出现后至少进行了6个月的长期临床随访才得出诊断。F-PET扫描使用ECAT EXACT HR+扫描仪在二维和三维模式下进行，有无衰减校正。沿骨/假体或骨/骨水泥界面包括胫骨干或股骨部件一半出现中等或高摄取被怀疑为无菌性松动。结果与X线平片进行比较。我们发现敏感性为100%，特异性为56%，准确性为71%。未检测到假阴性结果，4例患者中有1个部件为假阳性。同一患者X线平片的敏感性、特异性和准确性分别为43%、86%和64%。总之，由于其出色的空间分辨率，PET似乎是早期诊断疼痛性全膝关节置换术的一种有前景的新方法。结合亲骨性示踪剂[（18）F]氟化物，PET能够检测无菌性松动并与单纯滑膜炎相鉴别。我们的初步结果表明，尽管我们研究的患者数量较少，但F-PET可能是一种有用的工具。
