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18F FDG-PET/CT在检测髋关节假体感染中的潜在临床作用:一项针对接受带临时间隔器的两阶段翻修关节成形术患者的研究

Potential clinical role of 18F FDG-PET/CT in detecting hip prosthesis infection: a study in patients undergoing two-stage revision arthroplasty with an interim spacer.

作者信息

Chen S H, Ho K C, Hsieh P H, Lee M S S, Yen T C

机构信息

Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.

出版信息

Q J Nucl Med Mol Imaging. 2010 Aug;54(4):429-35.


DOI:
PMID:20823810
Abstract

AIM: We evaluated the potential role of [18F]fluorodeoxyglucose-positron emission tomography/computed tomography ([18F]FDG-PET/CT) to identify latent infections at the site of an interim hip spacer after resection arthroplasty for hip prosthesis infection. METHODS: Twelve patients with an interim hip spacer following resection arthroplasty (Group A) were investigated. Twelve patients with painful primary hip prostheses served as controls (Group B). All underwent PET/CT before surgery. Both non-attenuation-corrected (NAC) and attenuation-corrected (AC) images were analyzed. Serum C-reactive protein (CRP) levels were measured in 22 patients. Elevated CRP level was defined as >/=10 mg/L. The diagnosis of infection was based on the results of intraoperative tissue cultures, intraoperative pathology, and clinical follow-up. RESULTS: FDG-PET/CT had 100% sensitivity and 100% negative predictive value for detection of latent infection in both groups. However, there were 4 and 3 false positive cases in Group A and Group B, respectively. Specificity improved from 50% to 62.5% in Group A, and from 62.5% to 87.5% in Group B when using NAC instead of AC. Seventeen patients had CRP values >/=10 mg/L, but only 8 were true positive for infection. FDG-PET/CT ruled out infection in 77.8% (7/9) of false-positive cases identified by CRP levels. CONCLUSION: FDG-PET/CT is highly sensitive to detect latent infections in prosthetic hips and in interim hip spacers. The high negative predictive value of PET/CT scans is useful to rule out infections in patients with persistently elevated CRP levels. PET/CT might serve as an auxiliary tool to exclude latent infections in patients posing a clinical diagnostic dilemma.

摘要

目的:我们评估了[18F]氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描([18F]FDG-PET/CT)在髋关节假体感染切除关节成形术后临时髋关节间隔物部位识别潜在感染的潜在作用。 方法:对12例切除关节成形术后使用临时髋关节间隔物的患者(A组)进行了研究。12例原发性髋关节假体疼痛的患者作为对照(B组)。所有患者在手术前均接受了PET/CT检查。对未进行衰减校正(NAC)和进行了衰减校正(AC)的图像均进行了分析。对22例患者测量了血清C反应蛋白(CRP)水平。CRP水平升高定义为≥10mg/L。感染的诊断基于术中组织培养、术中病理及临床随访结果。 结果:FDG-PET/CT对两组潜在感染的检测灵敏度均为100%,阴性预测值均为100%。然而,A组和B组分别有4例和3例假阳性病例。当使用NAC而非AC时,A组的特异性从50%提高到62.5%,B组从62.5%提高到87.5%。17例患者的CRP值≥10mg/L,但只有8例感染为真阳性。FDG-PET/CT排除了77.8%(7/9)由CRP水平确定的假阳性病例中的感染。 结论:FDG-PET/CT对检测假体髋关节和临时髋关节间隔物中的潜在感染高度敏感。PET/CT扫描的高阴性预测值有助于排除CRP水平持续升高患者的感染。PET/CT可能作为排除临床诊断存在困境患者潜在感染的辅助工具。

相似文献

[1]
Potential clinical role of 18F FDG-PET/CT in detecting hip prosthesis infection: a study in patients undergoing two-stage revision arthroplasty with an interim spacer.

Q J Nucl Med Mol Imaging. 2010-8

[2]
The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: results from a prospective, blinded study.

BMC Musculoskelet Disord. 2006-3-3

[3]
Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis.

Acta Radiol. 2018-5

[4]
The value of (18)FDG-PET for the detection of infected hip prosthesis.

Eur J Nucl Med Mol Imaging. 2003-5

[5]
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Orthopedics. 2011-10-5

[6]
The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses.

Nucl Med Commun. 2002-9

[7]
Persistent non-specific FDG uptake on PET imaging following hip arthroplasty.

Eur J Nucl Med Mol Imaging. 2002-10

[8]
Comparative analysis of dual-phase 18F-fluoride PET/CT and three phase bone scintigraphy in the evaluation of septic (or painful) hip prostheses: A prospective study.

J Orthop Sci. 2016-3

[9]
Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria.

Bone Joint J. 2019-8

[10]
The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants.

J Nucl Med. 2001-1

引用本文的文献

[1]
Diagnostic accuracy of positron emission tomography/computerized tomography for periprosthetic joint infection of hip: systematic review and meta-analysis.

J Orthop Surg Res. 2023-8-30

[2]
Performance characteristics of F-fluorodeoxyglucose in non-infected hip replacement.

Front Med (Lausanne). 2023-1-5

[3]
A Systematic Review and Meta-Analysis on the Accuracy of Fluorodeoxyglucose Positron Emission Tomography/ Computerized Tomography for Diagnosing Periprosthetic Joint Infections.

Front Surg. 2022-6-1

[4]
Metabolic Pattern of Asymptomatic Hip-Prosthesis by 18F-FDG-Positron-Emission-Tomography.

Iran J Radiol. 2015-1-12

[5]
(99m)tc-Ubiquicidin [29-41], a Promising Radiopharmaceutical to Differentiate Orthopedic Implant Infections from Sterile Inflammation.

Iran J Pharm Res. 2013

[6]
Application of temporarily functional antibiotic-containing bone cement prosthesis in revision hip arthroplasty.

Eur J Orthop Surg Traumatol. 2014-1

[7]
Prosthetic joint infections: radionuclide state-of-the-art imaging.

Eur J Nucl Med Mol Imaging. 2012-2-24

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