Xu Tingting, Zeng Yalan, Yang Xiao, Liu Guangfu, Lv Taiyong, Yang Hongbin, Jiang Fei, Chen Yue
Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
Bone Joint Res. 2022 Jun;11(6):398-408. doi: 10.1302/2046-3758.116.BJR-2021-0464.R1.
We aimed to evaluate the utility of Ga-citrate positron emission tomography (PET)/CT in the differentiation of periprosthetic joint infection (PJI) and aseptic loosening (AL), and compare it with Tc-methylene bisphosphonates (Tc-MDP) bone scan.
We studied 39 patients with suspected PJI or AL. These patients underwent Ga-citrate PET/CT, Tc-MDP three-phase bone scan and single-photon emission CT (SPECT)/CT. PET/CT was performed at ten minutes and 60 minutes after injection, respectively. Images were evaluated by three nuclear medicine doctors based on: 1) visual analysis of the three methods based on tracer uptake model, and PET images attenuation-corrected with CT and those not attenuation-corrected with CT were analyzed, respectively; and 2) semi-quantitative analysis of PET/CT: maximum standardized uptake value (SUVmax) of lesions, SUVmax of the lesion/SUVmean of the normal bone, and SUVmax of the lesion/SUVmean of the normal muscle. The final diagnosis was based on the clinical and intraoperative findings, and histopathological and microbiological examinations.
Overall, 23 and 16 patients were diagnosed with PJI and AL, respectively. The sensitivity and specificity of three-phase bone scan and SPECT/CT were 100% and 62.5%, 82.6%, and 100%, respectively. Attenuation correction (AC) at 60 minutes and non-AC at 60 minutes of PET/CT had the same highest sensitivity and specificity (91.3% and 100%), and AC at 60 minutes combined with SPECT/CT could improve the diagnostic efficiency (sensitivity = 95.7%). Diagnostic efficacy of the SUVmax was low (area under the curve (AUC) of ten minutes and 60 minutes was 0.814 and 0.806, respectively), and SUVmax of the lesion/SUVmean of the normal bone at 60 minutes was the best semi-quantitative parameter (AUC = 0.969).
Ga-citrate showed the potential to differentiate PJI from AL, and visual analysis based on uptake pattern of tracer was reliable. The visual analysis method of AC at 60 minutes, combined with Tc-MDP SPECT/CT, could improve the sensitivity from 91.3% to 95.7%. In addition, a major limitation of our study was that it had a limited sample size, and more detailed studies with a larger sample size are warranted. Cite this article: 2022;11(6):398-408.
我们旨在评估枸橼酸镓正电子发射断层扫描（PET）/CT在鉴别假体周围关节感染（PJI）和无菌性松动（AL）方面的效用，并将其与锝-亚甲基二膦酸盐（Tc-MDP）骨扫描进行比较。
我们研究了39例疑似PJI或AL的患者。这些患者接受了枸橼酸镓PET/CT、Tc-MDP三相骨扫描和单光子发射计算机断层扫描（SPECT）/CT。PET/CT分别在注射后10分钟和60分钟进行。由三名核医学医生基于以下方面评估图像：1）基于示踪剂摄取模型对三种方法进行视觉分析，分别分析经CT衰减校正和未经CT衰减校正的PET图像；2）对PET/CT进行半定量分析：病变的最大标准化摄取值（SUVmax）、病变的SUVmax/正常骨的SUVmean以及病变的SUVmax/正常肌肉的SUVmean。最终诊断基于临床和术中发现以及组织病理学和微生物学检查。
总体而言，分别有23例和16例患者被诊断为PJI和AL。三相骨扫描和SPECT/CT的敏感性和特异性分别为100%和62.5%、82.6%和100%。PET/CT在60分钟时的衰减校正（AC）和60分钟时的非AC具有相同的最高敏感性和特异性（91.3%和100%），60分钟时的AC与SPECT/CT联合可提高诊断效率（敏感性 = 95.7%）。SUVmax的诊断效能较低（10分钟和60分钟时的曲线下面积（AUC）分别为0.814和0.806），60分钟时病变的SUVmax/正常骨的SUVmean是最佳的半定量参数（AUC = 0.969）。
枸橼酸镓显示出区分PJI和AL的潜力，基于示踪剂摄取模式的视觉分析是可靠的。60分钟时AC的视觉分析方法与Tc-MDP SPECT/CT联合可将敏感性从91.3%提高到95.7%。此外，我们研究的一个主要局限性是样本量有限，需要进行更大样本量的更详细研究。引用本文：2022；11(6)：398 - 408。
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