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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Aksaray, Istanbul, Turkey

    Sabire Yılmaz Aksoy, Sertac Asa, Meftune Ozhan, M. Sait Sager, Metin Halac, Levent Kabasakal, Kerim Sönmezoglu & Bedii Kanmaz

  2. Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Istanbul, Istanbul, Turkey

    Meltem Ocak

  3. Department of Nuclear Medicine, Duzce University School of Medicine, Duzce, Turkey

    Melih Engin Erkan

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  1. Sabire Yılmaz Aksoy
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  2. Sertac Asa
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Correspondence to Sabire Yılmaz Aksoy.

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Aksoy, S.Y., Asa, S., Ozhan, M. et al. FDG and FDG-labelled leucocyte PET/CT in the imaging of prosthetic joint infection. Eur J Nucl Med Mol Imaging 41, 556–564 (2014). https://doi.org/10.1007/s00259-013-2597-2

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  • DOI: https://doi.org/10.1007/s00259-013-2597-2

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