Boero Michele, Allocca Michela, Pisu Nicola, Sanna Silvia, Ruggiero Alessia, Pung Bi Llie Joy, Margotti Simone, Dessì Giuseppe
Nuclear Medicine, Brotzu Hospital, Cagliari (Italy).
Orthopedic Unit, Brotzu Hospital, Cagliari (Italy).
Orthop Rev (Pavia). 2022 Nov 12;14(4):39646. doi: 10.52965/001c.39646. eCollection 2022.
When faced with a painful knee replacement, ruling out infection is mandatory to set the correct therapeutic approach. However, it is not always easy, especially in subclinical/chronic infections. A multidisciplinary approach is necessary to assess in the most correct way each case of suspected periprosthetic knee joint infection. This review explores the role of nuclear medicine investigations in the management of periprosthetic knee infections and their proper use within a multidisciplinary pathway.
A PubMed search was conducted selecting studies from the past 10 years.
Triphasic bone scintigraphy has high sensitivity (93%) but poor specificity (56%) for periprosthetic joint infections of the knee, with a high negative predictive value (NPV), ranging from 96% to 100%. Consequently, a negative bone scan is useful in ruling out infection. In contrast, radiolabeled leukocyte scintigraphy is characterized by a sensitivity of 85.7-93%, specificity of 93.6-100%, diagnostic accuracy of 92.6-98%, NPV of 93-97.8%, and positive predictive value (PPV) of 66.7-100%. By adding a tomographic acquisition with hybrid single-photon emission computed tomography combined with computed tomography technique (SPECT/CT), the diagnostic accuracy increases. Because 18F-fluorodeoxyglucose (FDG) accumulates at both sites of inflammation and infection, FDG positron emission tomography (PET/CT) shows low specificity.
A common decision-making process in the diagnosis of periprosthetic joint infection is not yet validated and multidisciplinary integration is mandatory. In this context, nuclear medicine can contribute decisively.
当面对膝关节置换术后疼痛时，排除感染对于确定正确的治疗方法至关重要。然而，这并非总是容易做到，尤其是在亚临床/慢性感染的情况下。需要采用多学科方法以最正确的方式评估每一例疑似人工膝关节周围感染的病例。本综述探讨了核医学检查在人工膝关节周围感染管理中的作用及其在多学科诊疗路径中的合理应用。
在PubMed上进行检索，选取过去10年的研究。
三相骨闪烁显像对膝关节人工关节周围感染具有较高的敏感性（93%），但特异性较差（56%），阴性预测值较高，范围为96%至100%。因此，骨扫描阴性有助于排除感染。相比之下，放射性标记白细胞闪烁显像的敏感性为85.7 - 93%，特异性为93.6 - 100%，诊断准确性为92.6 - 98%，阴性预测值为93 - 97.8%，阳性预测值为66.7 - 100%。通过添加断层采集的单光子发射计算机断层扫描与计算机断层扫描相结合的技术（SPECT/CT），诊断准确性会提高。由于18F - 氟脱氧葡萄糖（FDG）在炎症和感染部位均有积聚，FDG正电子发射断层扫描（PET/CT）显示特异性较低。
人工关节周围感染诊断中的常见决策过程尚未得到验证，多学科整合是必不可少的。在这种情况下，核医学可以发挥决定性作用。
