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99mTc-HMPAO-Leukocyte Scintigraphy in Patients with Symptomatic Total Hip or Knee Arthroplasty: Improved Diagnostic Accuracy by Means of Semiquantitative Evaluation

Ettore Pelosi, MD1,2, Cinzia Baiocco, MD2, Michele Pennone, MD2, Giuseppe Migliaretti, MD3, Teresio Varetto, MD2, Agostino Maiello, MD4, Marilena Bellò, MD2 and Gianni Bisi, PhD2

1 Dottorato di Ricerca Radioimmunolocalizzazione dei Tumori Umani, Università di Torino, Torino, Italy
2 Servizio di Medicina Nucleare, Università di Torino, Ospedale S. Giovanni Battista, Torino, Italy
3 Dipartimento di Sanità Pubblica e Microbiologia, Università di Torino, Ospedale S. Giovanni Battista, Torino, Italy
4 Divisione di Malattie Infettive, Università di Torino, Ospedale Amedeo di Savoia, Torino, Italy



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  		FIGURE 1. 99mTc-HMPAO-leukocyte scintigraphy in suspected left hip prosthesis infection: semiquantitative analysis. SRearly = 39 mean counts/pixel; SRlate = 8.2 mean counts/pixel; RRearly = 69.9 mean counts/pixel; RRlate = 14.7 mean counts/pixel; Kearly = 0.56; Klate = 0.56; time decay-corrected SRearly = 43.4 mean counts/pixel. Because Klate = Kearly, the scan is considered to be negative.

 


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  		FIGURE 2. 99mTc-HMPAO-leukocyte scintigraphy in a patient with bilateral knee prostheses and suspected left knee prosthesis infection: semiquantitative analysis. SRearly = 64.7 mean counts/pixel; SRlate = 28.1 mean counts/pixel; RRearly = 61.9 mean counts/pixel; RRlate = 13.7 mean counts/pixel; Kearly = 1.05; Klate = 2.05. Because Klate > Kearly, the scan is considered to be positive.

 


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  		FIGURE 3. 99mTc-HMPAO-leukocyte scintigraphy in suspected left hip prosthesis infection: unambiguous case of infection. Periprosthetic activity is evident around the hip replacement (arrows). Semiquantitative analysis (data not reported) confirms an increase of K with time.

 


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  		FIGURE 4. 99mTc-HMPAO-leukocyte scintigraphy in suspected left hip prosthesis infection: ambiguous case of infection (same as Fig. 1). The intertrochanteric activity of the hip replacement does not clearly change with time (arrows).

 




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