Brammen Lindsay, Palestro Christopher J, Holinka Johannes, Windhager Reinhard, Sinzinger Helmut
ISOTOPIX - Institute for Nuclear Medicine, Vienna, Mariannengasse 30, A-1090, Vienna, Austria; Department of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Nucl Med Rev Cent East Eur. 2017;20(2):81-87. doi: 10.5603/NMR.2017.0013.
Labeled leukocyte scintigraphy (LS) is considered a valuable tool in preoperative diagnosis of prosthetic joint infections (PJI). The aim of this study was to determine the accuracy of LS combined with bone marrow scintigraphy (BMS), as well as inflammation markers CRP and WBC, in detecting infection in patients with prosthetic joints.
This study included patients suspected of having PJI between January and September 2013 at the Vienna General Hospital who underwent imaging with 99mTc-HMPAO labeled autologous leukocytes and subsequent BMS. Diagnostic accuracy was assessed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
A total of 48 patients were included. The most common joint investigated was knee (25), followed by hip (9), shoulder (2), and elbow (1). Other parts of the body investigated included the femur (6), tibia (2), leg (2), and foot (1). The pathogens most frequently isolated included Staphylococcus epidermidis and Candida albicans. The sensitivity of LS was 60%, specificity 97%, PPV 86% and NPV 90%. Overall accuracy was calculated to be 90%.
This study was able to demonstrate that 99mTc-HMPAO labeled autologous leukocytes in patients presenting with symptoms of PJI is accurate. In contrast, however, inflammation markers CRP and WBC are not accurate pre-diagnostic markers for PJI.
标记白细胞闪烁扫描术（LS）被认为是人工关节感染（PJI）术前诊断的一种有价值的工具。本研究的目的是确定LS联合骨髓闪烁扫描术（BMS）以及炎症标志物CRP和白细胞在检测人工关节患者感染方面的准确性。
本研究纳入了2013年1月至9月在维也纳总医院疑似患有PJI且接受了用99mTc-HMPAO标记的自体白细胞成像及随后的BMS检查的患者。从敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）方面评估诊断准确性。
共纳入48例患者。研究最多的关节是膝关节（25例），其次是髋关节（9例）、肩关节（2例）和肘关节（1例）。研究的身体其他部位包括股骨（6例）、胫骨（2例）、腿部（2例）和足部（1例）。最常分离出的病原体包括表皮葡萄球菌和白色念珠菌。LS的敏感性为60%，特异性为97%，PPV为86%，NPV为90%。总体准确率计算为90%。
本研究能够证明，对于出现PJI症状的患者，99mTc-HMPAO标记的自体白细胞检查是准确的。然而，相比之下，炎症标志物CRP和白细胞不是PJI准确的诊断前标志物。
