The Role of Nuclear Medicine Imaging with 18F-FDG PET/CT, Combined 111In-WBC/99mTc-Nanocoll, and 99mTc-HDP SPECT/CT in the Evaluation of Patients with Chronic Problems after TKA or THA in a Prospective Study

Ramune Aleksyniene; Victor Iyer; Henrik Christian Bertelsen; Majbritt Frost Nilsson; Vesal Khalid; Henrik Carl Schønheyder; Lone Heimann Larsen; Poul Torben Nielsen; Andreas Kappel; Trine Rolighed Thomsen; Jan Lorenzen; Iben Ørsted; Ole Simonsen; Peter Lüttge Jordal; Sten Rasmussen

doi:10.3390/diagnostics12030681

The Role of Nuclear Medicine Imaging with ¹⁸F-FDG PET/CT, Combined ¹¹¹In-WBC/^99mTc-Nanocoll, and ^99mTc-HDP SPECT/CT in the Evaluation of Patients with Chronic Problems after TKA or THA in a Prospective Study

Diagnostics (Basel). 2022 Mar 10;12(3):681. doi: 10.3390/diagnostics12030681.

Authors

Ramune Aleksyniene¹, Victor Iyer^{1

2}, Henrik Christian Bertelsen¹, Majbritt Frost Nilsson¹, Vesal Khalid^{3

4}, Henrik Carl Schønheyder⁵, Lone Heimann Larsen⁵, Poul Torben Nielsen⁶, Andreas Kappel⁶, Trine Rolighed Thomsen^{7

8}, Jan Lorenzen⁸, Iben Ørsted⁹, Ole Simonsen⁶, Peter Lüttge Jordal⁸, Sten Rasmussen^{3

4}

Affiliations

¹ Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.
² Department of Radiology and Molecular Medicine, University Hospital Uppsala, 75237 Uppsala, Sweden.
³ Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark.
⁴ Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark.
⁵ Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark.
⁶ Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark.
⁷ Center for Microbial Communities, Aalborg University, 9220 Aalborg, Denmark.
⁸ Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark.
⁹ Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark.

Abstract

Background: The aim of this prospective study was to assess the diagnostic value of nuclear imaging with ¹⁸F-FDG PET/CT (FDG PET/CT), combined ¹¹¹In-WBC/^99mTc-Nanocoll, and ^99mTc-HDP SPECT/CT (dual-isotope WBC/bone marrow scan) for patients with chronic problems related to knee or hip prostheses (TKA or THA) scheduled by a structured multidisciplinary algorithm.

Materials and methods: Fifty-five patients underwent imaging with ^99mTc-HDP SPECT/CT (bone scan), dual-isotope WBC/bone marrow scan, and FDG PET/CT. The final diagnosis of prosthetic joint infection (PJI) and/or loosening was based on the intraoperative findings and microbiological culture results and the clinical follow-up.

Results: The diagnostic performance of dual-isotope WBC/bone marrow SPECT/CT for PJI showed a sensitivity of 100% (CI 0.74-1.00), a specificity of 97% (CI 0.82-1.00), and an accuracy of 98% (CI 0.88-1.00); for PET/CT, the sensitivity, specificity, and accuracy were 100% (CI 0.74-1.00), 71% (CI 0.56-0.90), and 79% (CI 0.68-0.93), respectively.

Conclusions: In a standardized prospectively scheduled patient group, the results showed highly specific performance of combined dual-isotope WBC/bone marrow SPECT/CT in confirming chronic PJI. FDG PET/CT has an appropriate accuracy, but the utility of its use in the clinical diagnostic algorithm of suspected PJI needs further evidence.

Keywords: FDG PET/CT; bone scan; dual-isotope WBC/bone marrow scan; hybrid imaging; labeled leucocyte imaging; nuclear imaging; periprosthetic infection; prosthetic joint infection.