RT Journal Article
SR Electronic
T1 Diagnosing Infection in the Failed Joint Replacement: A Comparison of Coincidence Detection <sup>18</sup>F-FDG and <sup>111</sup>In-Labeled Leukocyte/<sup>99m</sup>Tc-Sulfur Colloid Marrow Imaging
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1864
OP 1871
VO 45
IS 11
A1 Love, Charito
A1 Marwin, Scott E.
A1 Tomas, Maria B.
A1 Krauss, Eugene S.
A1 Tronco, Gene G.
A1 Bhargava, Kuldeep K.
A1 Nichols, Kenneth J.
A1 Palestro, Christopher J.
YR 2004
UL http://jnm.snmjournals.org/content/45/11/1864.abstract
AB The objectives of this study were to investigate 18F-FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements. Methods: Fifty-nine patients—with painful, failed, lower extremity joint prostheses, 40 hip and 19 knee—who underwent 18F-FDG, labeled leukocyte, and bone marrow imaging, and had histopathologic and microbiologic confirmation of the final diagnosis, formed the basis of this investigation. 18F-FDG images were interpreted as positive for infection using 4 different criteria: criterion 1: any periprosthetic activity, regardless of location or intensity; criterion 2: periprosthetic activity on the 18F-FDG image, without corresponding activity on the marrow image; criterion 3: only bone–prosthesis interface activity, regardless of intensity; criterion 4: semiquantitative analysis—a lesion-to-background ratio was generated, and the cutoff value yielding the highest accuracy for determining the presence of infection was determined. Labeled leukocyte/marrow images were interpreted as positive for infection when periprosthetic activity was present on the labeled leukocyte image without corresponding activity on the marrow image. Results: Twenty-five (42%) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of 18F-FDG, by criterion, were as follows: criterion 1: 100%, 9%, 47%; criterion 2: 96%, 35%, 61%; criterion 3: 52%, 44%, 47%; criterion 4: 36%, 97%, 71%. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100%, 91%, and 95%, respectively. WBC/marrow imaging, which was more accurate than any of the 18F-FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P &lt; 0.001) and criterion 4 (P &lt; 0.001) and was significantly more specific than criterion 1 (P &lt; 0.001), criterion 2 (P &lt; 0.001), and criterion 3 (P &lt; 0.001). Conclusion: Regardless of how the images are interpreted, coincidence detection–based 18F-FDG imaging is less accurate than, and cannot replace, labeled leukocyte/marrow imaging for diagnosing infection of the failed prosthetic joint.