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First published online March 16, 2009, 10.2967/jnumed.108.059345
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The Use of 99mTc-Recombinant Human Annexin V Imaging for Differential Diagnosis of Aseptic Loosening and Low-Grade Infection in Hip and Knee Prostheses

Mordechai Lorberboym1, Zeev Feldbrin2, David Hendel2, Francis G. Blankenberg3 and Pinhas Schachter4

1 Department of Nuclear Medicine of the Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 2 Department of Orthopedic Surgery of the Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3 Department of Radiology, Stanford University Hospital, Stanford, California; and 4 Department of General Surgery of the Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel


Figure 1
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  		FIGURE 1.  A 79-y-old woman with unilateral right hip prosthesis for 15 y. Focus of increased MDP activity is seen at distal aspect of prosthesis, and second focus is seen proximally (planar image on left). Patient's annexin V study was read as negative (planar image on right).

 

Figure 2
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  		FIGURE 2.  A 77-y-old woman with bilateral hip replacements. Left hip prosthesis shows normal 99mTc-annexin V activity, and right shows increased annexin V uptake on planar image (arrow). Tracer uptake is better visualized on representative coronal SPECT slices shown on right (arrows).

 

Figure 3
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  		FIGURE 3.  A 78-y-old woman with history of subcapital fracture of her left femur, leading to avascular necrosis and total hip replacement. Patient's bone scan shows diffusely increased MDP uptake around left hip prosthesis (planar image on left). Annexin study shows increased linear uptake on lateral aspect of prosthesis (planar image on right; arrows).

 

Figure 4
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  		FIGURE 4.  A 76-y-old man with painful unilateral right knee prosthesis and signs of loosening on plain radiograph. Linear increased activity around prosthesis on bone scan (planar image far left; arrows) is demonstrated, with similar activity noted on anterior (Ant) and posterior (Post) views of annexin study (planar images; center and right).

 

Figure 5
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  		FIGURE 5.  A 69-y-old woman with left knee prosthesis, showing focal increased annexin activity in left medial tibial plateau (arrow) but no evidence of infection.

 




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