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FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection

  • Sabire Yılmaz AksoyEmail author
  • Sertac Asa
  • Meftune Ozhan
  • Meltem Ocak
  • M. Sait Sager
  • Melih Engin Erkan
  • Metin Halac
  • Levent Kabasakal
  • Kerim Sönmezoglu
  • Bedii Kanmaz
Original Article

Abstract

Purpose

The demand for arthroplasty is rapidly growing as a result of the ageing of the population. Although complications such as heterotrophic ossification, fracture and dislocation are relatively rare, differentiating aseptic loosening, the most common complication of arthroplasty from infection, is a major challenge for clinicians. Radionuclide imaging is currently the imaging modality of choice since it is not affected by orthopaedic hardware. Whereas FDG PET/CT imaging has been widely used in periprosthetic infection, it cannot discriminate aseptic from septic inflammation. In this study we aimed to evaluate the role of FDG PET/CT and FDG-labelled leucocyte PET/CT in the diagnosis of periprosthetic infection.

Methods

Of 54 patients with painful joint arthroplasty who were imaged by FDG PET/CT for diagnosis of periprosthetic infection examined, 46 (36 women, 10 men; mean age 61.04 ± 12.2 years, range 32 – 89 years) with 54 painful joint prostheses (19 hip, 35 knee) with grade 2 (above liver uptake) FDG accumulation on FDG PET/CT were included in the study and these 46 patients also underwent FDG-labelled leucocyte PET/CT. Final diagnoses were made by histopathological-microbiological culture or clinical follow-up.

Results

The final diagnosis showed infection in 15 (28 %) and aseptic loosening in 39 (72 %) of the 54 prostheses. FDG PET/CT was found to have a positive predictive value of 28 % (15/54). Since patients with no FDG uptake on FDG PET/CT were excluded from the study, the sensitivity, specificity, negative predictive value and accuracy could not be calculated. The sensitivity, specificity, and positive and negative predictive values of FDG-labelled leucocyte PET/CT were 93.3 % (14/15), 97.4 % (38/39), 93.3 % and 97.4 %, respectively.

Conclusion

Since FDG is not specific to infection, the specificity of FDG PET/CT was very low. FDG-labelled leucocyte PET/CT with its high specificity may be a useful method and better than labelled leucocyte scintigraphy in periprosthetic infection imaging.

Keywords

FDG-labelled leucocytes Prosthetic joint infection PET/CT 

Notes

Conflicts of interest

None.

References

  1. 1.
    National Institutes of Health. Deep infections of total joint replacement. PA number PA-00-014. NIH Bethesda; 1999.Google Scholar
  2. 2.
    Mulamba L, Ferrant A, Leners N, de Nayer P, Rombouts JJ, Vincent A. Indium-111 leucocyte scanning in the evaluation of painful hip arthroplasty. Acta Orthop Scand. 1983;54(5):695–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med. 1990;31(12):1950–5.PubMedGoogle Scholar
  4. 4.
    Palestro CJ, Swyer AJ, Kim CK, Goldsmith SJ. Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging. Radiology. 1991;179(3):645–8.PubMedGoogle Scholar
  5. 5.
    Love C, Tomas MB, Marwin SE, Pugliese PV, Palestro CJ. Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics. 2001;21:1229–38.PubMedCrossRefGoogle Scholar
  6. 6.
    El-Maghraby TA, Moustafa HM, Pauwels EK. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. Q J Nucl Med Mol Imaging. 2006;50:167–92.PubMedGoogle Scholar
  7. 7.
    Vinjamuri S, Hall AV, Solanki KK, Bomanji J, Siraj Q, O’Shaughnessy E, et al. Comparison of 99mTc infecton imaging with radiolabelled white-cell imaging in the evaluation of bacterial infection. Lancet. 1996;347(8996):233–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Sonmezoglu K, Sonmezoglu M, Halac M, Akgün I, Türkmen C, Onsel C, et al. Usefulness of 99mTc-ciprofloxacin (Infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy. J Nucl Med. 2001;42(4):567–74.PubMedGoogle Scholar
  9. 9.
    Sarda L, Crémieux AC, Lebellec Y, Meulemans A, Lebtahi R, Hayem G, et al. Inability of 99mTc-ciprofloxacin scintigraphy to discriminate between septic and sterile osteoarticular diseases. J Nucl Med. 2003;44(6):920–6.PubMedGoogle Scholar
  10. 10.
    Dumarey N, Blocklet D, Appelboom T, Tant L, Schoutens A. Infecton is not specific for bacterial osteo-articular infective pathology. Eur J Nucl Med Mol Imaging. 2002;29(4):530–5.PubMedCrossRefGoogle Scholar
  11. 11.
    van Eerd JE, Oyen WJ, Harris TD, Rennen HJ, Edwards DS, Liu S, et al. A bivalent leukotriene B(4) antagonist for scintigraphic imaging of infectious foci. J Nucl Med. 2003;44(7):1087–91.PubMedGoogle Scholar
  12. 12.
    Fischman AJ, Babich JW, Strauss HW. A ticket to ride: peptide radiopharmaceuticals. J Nucl Med. 1993;34(12):2253–63.PubMedGoogle Scholar
  13. 13.
    De Winter F, Vogelaers D, Gemmel F, Dierckx RA. Promising role of 18-F-fluoro-D-deoxyglucose positron emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis. 2002;21(4):247–57.PubMedCrossRefGoogle Scholar
  14. 14.
    Chacko TK, Zhuang H, Nakhoda KZ, Moussavian B, Alavi A. Applications of fluorodeoxyglucose positron emission tomography in the diagnosis of infection. Nucl Med Commun. 2003;24(6):615–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–80.PubMedGoogle Scholar
  16. 16.
    Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med. 1996;26:308–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Osman S, Danpure HJ. The use of 2-[18F]fluoro-2-deoxy-D-glucose as a potential in vitro agent for labelling human granulocytes for clinical studies by positron emission tomography. Int J Rad Appl Instrum B. 1992;19(2):183–90.PubMedCrossRefGoogle Scholar
  18. 18.
    Rini JN, Bhargava KK, Tronco GG, Singer C, Caprioli R, Marwin SE, et al. PET with FDG-labeled leukocytes versus scintigraphy with 111In-oxine-labeled leukocytes for detection of infection. Radiology. 2006;238(3):978–87.PubMedCrossRefGoogle Scholar
  19. 19.
    Forstrom LA, Mullan BP, Hung JC, Lowe VJ, Thorson LM. 18F-FDG labelling of human leukocytes. Nucl Med Commun. 2000;21(7):691–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Lafont P, Morelec I, Fraysse M, Got P, Houzard C, Confavreux A, et al. 18F-FDG labelled leukocytes in vitro functional tests: viability, chemotaxis and phagocytosis assays. Open Nucl Med J. 2011;3:25–9.CrossRefGoogle Scholar
  21. 21.
    van der Bruggen W, Bleeker-Rovers CP, Boerman OC, Gotthardt M, Oyen WJ. PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review. Semin Nucl Med. 2010;40(1):3–15.PubMedCrossRefGoogle Scholar
  22. 22.
    Zhuang H, Chacko TK, Hickeson M, Stevenson K, Feng Q, Ponzo F, et al. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty. Eur J Nucl Med Mol Imaging. 2002;29(10):1328–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Love C, Marwin SE, Tomas MB, Krauss ES, Tronco GG, Bhargava KK, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection fluorine-18 FDG and indium-111-labeled leukocyte/technetium-99m-sulfur colloid marrow imaging. J Nucl Med. 2004;45:1864–71.PubMedGoogle Scholar
  24. 24.
    Yao WJ, Hoh CK, Hawkins RA, Glaspy JA, Weil JA, Lee SJ, et al. Quantitative PET imaging of bone marrow glucose metabolic response to hematopoietic cytokines. J Nucl Med. 1995;36(5):794–9.PubMedGoogle Scholar
  25. 25.
    Chacko TK, Zhuang H, Stevenson K, Moussavian B, Alavi A. The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses. Nucl Med Commun. 2002;23:851–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K. The use of [18F] fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses. Nucl Med Commun. 2002;23:645–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Pio BS, Byrne FR, Aranda R, Boulay G, Spicher K, Song MH, et al. Noninvasive quantification of bowel inflammation through positron emission tomography imaging of 2-deoxy-2-[18F]fluoro-D-glucose-labeled white blood cells. Mol Imaging Biol. 2003;5(4):271–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Dumarey N, Egrise D, Blocklet D, Stallenberg B, Remmelink M, del Marmol V, et al. Imaging infection with 18F-FDG-labeled leukocyte PET/CT: initial experience in 21 patients. J Nucl Med. 2006;47:625–32.PubMedGoogle Scholar
  29. 29.
    Forstrom LA, Dunn WL, Mullan BP, Hung JC, Lowe VJ, Thorson LM. Biodistribution and dosimetry of [18F]fluorodeoxyglucose labelled leukocytes in normal human subjects. Nucl Med Commun. 2002;23:721–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Pellegrino D, Bonab AA, Dragotakes SC, Pitman JT, Mariani G, Carter EA. Inflammation and infection: imaging properties of 18F-FDG-labeled white blood cells versus 18F-FDG. J Nucl Med. 2005;46:1522–30.PubMedGoogle Scholar
  31. 31.
    Yılmaz S, Ocak M, Asa S, Aliyev A, Ozhan M, Halac M, et al. The different distribution patterns of FDG and FDG-labelled WBC in inflammatory and infectious lesions. Eur J Nucl Med Mol Imaging. 2012;39(10):1660–1.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sabire Yılmaz Aksoy
    • 1
    Email author
  • Sertac Asa
    • 1
  • Meftune Ozhan
    • 1
  • Meltem Ocak
    • 2
  • M. Sait Sager
    • 1
  • Melih Engin Erkan
    • 3
  • Metin Halac
    • 1
  • Levent Kabasakal
    • 1
  • Kerim Sönmezoglu
    • 1
  • Bedii Kanmaz
    • 1
  1. 1.Department of Nuclear Medicine, Cerrahpasa Medical FacultyUniversity of IstanbulAksarayTurkey
  2. 2.Department of Pharmaceutical Technology, Faculty of PharmacyUniversity of IstanbulIstanbulTurkey
  3. 3.Department of Nuclear MedicineDuzce University School of MedicineDuzceTurkey

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