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The Promising Role of ¹⁸F-FDG PET in Detecting Infected Lower Limb Prosthesis Implants

Division of Nuclear Medicine and Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; and Department of Nuclear Medicine, University of Leuven Hospital, Leuven, Belgium

View larger version (98K): [in a new window]   FIGURE 1. PET images of 60-y-old woman with painful right knee prosthesis proven infected by revision arthroplasty. Bone–prosthesis interface shows areas of intense uptake in both femoral and tibial component of prosthesis (arrowheads).

View larger version (120K): [in a new window]   FIGURE 2. (A) Coronal image of 72-y-old woman with hip prosthesis. Periprosthetic infection on right side was identified (arrowheads). (B) Coronal image of 76-y-old woman with bilateral hip prostheses. Both infection (arrowhead) and loosening (arrows) were shown. (C) Coronal image of 78-y-old man with painful left hip prosthesis. Arrowheads indicate periprosthetic infection and osteomyelitis. (D) Coronal image of 76-y-old woman with bilateral hip prostheses. FDG uptake is noted only around neck of prosthesis (arrows). FDG PET diagnosis of loosening was confirmed after revision arthroplasty.

View larger version (57K): [in a new window]   FIGURE 3. A 76-year-old woman with right hip prosthesis who presented with right hip pain. No focally increased FDG accumulation is seen around any portion of prosthesis on PET scan. Therefore, both infection and loosening were ruled out. Patient responded to conservative therapy during 16 mo of follow-up.

View larger version (67K): [in a new window]   FIGURE 4. Coronal images of 63-y-old man with painful right hip prosthesis. Loosening (short arrow), infection (arrowheads), and fistula (long arrow) are shown.