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The Journal of Nuclear Medicine Vol. 31 No. 12 1950-1955
© 1990 by Society of Nuclear Medicine
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Total-Hip Arthroplasty: Periprosthetic Indium-111-Labeled Leukocyte Activity and Complementary Technetium-99m-Sulfur Colloid Imaging in Suspected Infection

Christopher J. Palestro, Chun K. Kim, Alfred J. Swyer, James D. Capozzi, Robert W. Solomon and Stanley J. Goldsmith

Departments of Physics-Nuclear Medicine and Orthopedic Surgery, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, New York

Correspondence: For reprints contact: Christopher J. Palestro, MD, Box 1141, Dept. of Physics-Nuclear Medicine, Mt. Sinai Medical Center 1 Gustave L. Levy Place, New York, NY 10029.

ABSTRACT

Indium-111-labeled leukocyte images of 92 cemented total-hip arthroplasties were correlated with final diagnoses. Prostheses were divided into four zones: head (including acetabulum), trochanter, shaft, and tip. The presence (or absence) and intensity of activity in each zone was noted, and compared to the corresponding contralateral zone. Though present in all 23 infected arthroplasties, periprosthetic activity was also present in 77% of uninfected arthroplasties, and was greater than the contralateral zone 51% of the time. When analyzed by zone, head zone activity was the best criterion for infection (87% sensitivity, 94% specificity, 92% accuracy). Fifty of the arthroplasties were studied with combined labeled leukocyte/sulfur colloid imaging. Using incongruence of images as the criterion for infection, the sensitivity, specificity, and accuracy of the study were 100%, 97%, and 98%, respectively. While variable periprosthetic activity makes labeled leukocyte imaging alone unreliable for diagnosing hip arthroplasty infection, the addition of sulfur colloid imaging results in a highly accurate diagnostic procedure.




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