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

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 (99m)Tc-labelled antigranulocyte antibodies for diagnosing and localizing low-grade joint infections. METHODS:Planar scintigraphy using (99m)Tc-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 (99m)Tc-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.

journal_name

Eur J Nucl Med Mol Imaging

journal_title

European journal of nuclear medicine and molecular imaging

authors

Graute V,Feist M,Lehner S,Haug A,Müller PE,Bartenstein P,Hacker M

doi

10.1007/s00259-010-1431-3

subject

Has Abstract

pub_date

2010-08-01 00:00:00

pages

1751-9

issue

eissn

1619-7070

issn

1619-7089

journal_volume

pub_type

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