Oyen W J, Lemmens J A, Claessens R A, van Horn J R, Slooff T J, Corstens F H
Department of Nuclear Medicine, University Hospital Nijmegen, The Netherlands.
J Nucl Med. 1996 Jan;37(1):62-70.
Radiographic arthrography and bone scintigraphy are common diagnostic procedures used for evaluating total hip prostheses. In this study, both techniques are combined, and nuclear contrast imaging (nuclear arthrography) is added. The efficacy of the procedures is evaluated.
After intravenous injection of 99mTc-methylene diphosphonate (MDP), standard radiographic arthrography was performed in 105 patients (107 prostheses). The radiographic contrast medium was mixed with insoluble 111In-colloid (5 MBq/20 ml). After completion of the radiographic arthrography, nuclear arthrography was performed, and multiple-view dualisotope images (111In, 247-keV peak only) were recorded. Images were interpreted by superposition of the 111In image and the corresponding 99mTc-MDP image, the latter serving as a landmark for the position of the prosthesis and osseous structures. Findings at surgery were used as the gold standard.
In both cemented and uncemented acetabular and femoral components, nuclear arthrography performed better than or equal to radiographic arthrography (70%-90% and 60%-75%, respectively). Nuclear arthrography had higher diagnostic accuracy than 99mTc-MDP images alone.
Nuclear arthrography is a sensitive technique for detection of loosening of prostheses, offering added value over radiographic arthrography and bone scanning alone, especially for evaluation of the femoral component. Radiographic arthrography remains necessary not only for adequate deposition of contrast agents but also for detailed evaluation of osseous structures.
X 线关节造影和骨闪烁显像术是用于评估全髋关节假体的常见诊断方法。在本研究中，将这两种技术相结合，并增加了核素对比成像（核关节造影）。对这些方法的有效性进行评估。
静脉注射99mTc-亚甲基二膦酸盐（MDP）后，对105例患者（107个假体）进行标准X线关节造影。将X线造影剂与不溶性111In-胶体（5MBq/20ml）混合。完成X线关节造影后，进行核关节造影，并记录多视角双同位素图像（仅111In，247keV峰）。通过叠加111In图像和相应的99mTc-MDP图像来解读图像，后者作为假体和骨结构位置的标志。手术结果用作金标准。
在骨水泥型和非骨水泥型髋臼及股骨假体组件中，核关节造影的表现优于或等同于X线关节造影（分别为70%-90%和60%-75%）。核关节造影的诊断准确性高于单独的99mTc-MDP图像。
核关节造影是检测假体松动的敏感技术，相对于单独的X线关节造影和骨扫描具有附加价值，特别是在评估股骨组件方面。X线关节造影不仅对于造影剂的充分沉积是必要的，而且对于骨结构的详细评估也是必要的。
