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Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results

  • Vera Graute
  • Markus Feist
  • Sebastian Lehner
  • Alexander Haug
  • Peter Ernst Müller
  • Peter Bartenstein
  • Marcus Hacker
Original Article

Abstract

Purpose

Low-grade joint infections are characterized by infiltration of granulocytes, which mediate aspects of inflammatory changes. We evaluated retrospectively the contribution of SPECT/CT as an addition to planar scintigraphy with 99mTc-labelled antigranulocyte antibodies for diagnosing and localizing low-grade joint infections.

Methods

Planar scintigraphy using 99mTc-labelled antigranulocyte BW 250/183 antibodies was performed in 31 patients with suspected joint infections at 5 min, 5 h and 24 h after injection, with additional SPECT/CT performed 6 h after injection. With reference to gold standard clinical data, we assessed the diagnostic sensitivity of scintigraphy alone and in conjunction with SPECT/CT.

Results

Joint infections were diagnosed clinically in 9 of the 31 patients (1 hip and 8 knee prostheses). Planar scintigraphy revealed 6 true-positives, 13 true-negatives, 9 false-positives and 3 false-negative results, indicating sensitivity, specificity, positive and negative predictive values of, respectively, 0.66, 0.60, 0.4 and 0.81. With the addition of SPECT images, corresponding sensitivity, specificity, positive and negative predictive values increased to 0.89, 0.45, 0.40 and 0.91. Implementation of fused SPECT/CT led to a further increase to 0.89, 0.73, 0.57 and 0.94.

Conclusion

Relative to planar scintigraphy, SPECT with and without CT substantially improved the utility of imaging with 99mTc-labelled antigranulocyte antibodies for diagnosis and localization of suspected joint infections. Optimal accuracy was obtained through image fusion, which permitted anatomical allocation of foci of pathological tracer accumulation as well as providing information on the extent of the infection. This imaging method seems suited for selection of patients requiring surgical therapy.

Keywords

Antigranulocyte scintigraphy SPECT/CT Low-grade Joint infection 

Notes

Acknowledgements

The authors thank Dr. Paul Cumming for critical revisions of the manuscript.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Vera Graute
    • 1
  • Markus Feist
    • 2
  • Sebastian Lehner
    • 1
  • Alexander Haug
    • 1
  • Peter Ernst Müller
    • 2
  • Peter Bartenstein
    • 1
  • Marcus Hacker
    • 1
  1. 1.Department of Nuclear MedicineUniversity of MunichMunichGermany
  2. 2.Department of Orthopedic MedicineUniversity of MunichMunichGermany

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