Aro Erik, Seppänen Marko, Mäkelä Keijo T, Luoto Pauliina, Roivainen Anne, Aro Hannu T
Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.
Department of Clinical Physiology and Nuclear Medicine and Turku PET Centre, Turku University Hospital, Turku, Finland.
Clin Physiol Funct Imaging. 2018 Sep;38(5):847-855. doi: 10.1111/cpf.12493. Epub 2017 Dec 27.
Metal-on-metal (MoM) bearings in total hip arthroplasties and hip resurfacing arthroplasties have recently shown a new type of complication: adverse reactions to metal debris (ARMD). ARMD is characterized by local severe inflammation and tissue necrosis leading to implant failures. The gluteal muscle region is important for the patient outcome after revision surgery. This prospective positron emission tomography/computed tomography (PET/CT) study was undertaken to evaluate the characteristics of 2-deoxy-2-[ F]fluoro-d-glucose ([ F]FDG) and [ Ga]Gallium citrate ([ Ga]Citrate) PET/CT in ARMD patients. [ F]FDG and [ Ga]Citrate PET/CT were performed in 18 hip arthroplasty patients: 12 ARMD patients (with 16 MoM hips) and six arthroplasty controls without ARMD. Tracer uptake was evaluated visually, and maximum standardized uptake (SUV ) was measured in the gluteal muscle region. ARMD severity was graded by metal artefact reduction sequence-magnetic resonance imaging (MARS-MRI). Periprosthetic [ F]FDG uptake was observed in 15 of 16 hips, [ Ga]Citrate uptake in three of 16 hips, respectively. The distribution of tracer uptake resembled infection in three hips. In the gluteal muscle region, the SUV of [ F]FDG was significantly greater in hips with moderate and severe ARMD compared with the controls (P = 0·009 for [ F]FDG and P = 0·217 for [ Ga]Citrate). In patients who needed revision surgery, an intraoperative finding of gluteal muscle necrosis was associated with increased local SUV as detected by preoperative [ F]FDG (P = 0·039), but not by [ Ga]Citrate (P = 0·301). In conclusion, the inflammatory reaction to metal debris in hip arthroplasty patients is best visualized with [ F]FDG.
全髋关节置换术和髋关节表面置换术中的金属对金属（MoM）轴承最近出现了一种新型并发症：金属碎屑不良反应（ARMD）。ARMD的特征是局部严重炎症和组织坏死，导致植入物失效。臀肌区域对翻修手术后的患者预后很重要。本前瞻性正电子发射断层扫描/计算机断层扫描（PET/CT）研究旨在评估2-脱氧-2-[F]氟-D-葡萄糖（[F]FDG）和[Ga]枸橼酸镓（[Ga]枸橼酸盐）PET/CT在ARMD患者中的特征。对18例髋关节置换术患者进行了[F]FDG和[Ga]枸橼酸盐PET/CT检查：12例ARMD患者（16个MoM髋关节）和6例无ARMD的关节置换术对照患者。通过视觉评估示踪剂摄取情况，并在臀肌区域测量最大标准化摄取值（SUV）。通过金属伪影减少序列磁共振成像（MARS-MRI）对ARMD严重程度进行分级。16个髋关节中有15个观察到假体周围[F]FDG摄取，16个髋关节中有3个观察到[Ga]枸橼酸盐摄取。3个髋关节中示踪剂摄取分布类似于感染。在臀肌区域，与对照组相比，中度和重度ARMD髋关节的[F]FDG的SUV显著更高（[F]FDG为P = 0·009，[Ga]枸橼酸盐为P = 0·217）。在需要翻修手术的患者中，术中发现臀肌坏死与术前[F]FDG检测到的局部SUV增加相关（P = 0·039），但与[Ga]枸橼酸盐无关（P = 0·301）。总之，[F]FDG能最好地显示髋关节置换术患者对金属碎屑的炎症反应。
