Johan Teiler1,2, Marcus Ahl3,4, Börje Åkerlund3,4, Sara Wird5, Harald Brismar6,7, Annie Bjäreback8, Håkan Hedlund6,9, Maria Holstensson8, Rimma Axelsson6,8. 1. Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institute, Stockholm, Sweden - johan.teiler@ki.se. 2. Abdominal Radiology, Karolinska University Hospital, Huddinge, Sweden - johan.teiler@ki.se. 3. Department of Medicine, Karolinska Institute, Stockholm, Sweden. 4. Unit of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. 5. Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden. 6. Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institute, Stockholm, Sweden. 7. Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden. 8. Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden. 9. Department of Orthopedic Surgery, Visby General Hospital, Visby, Sweden.
Abstract
BACKGROUND: To investigate the sensitivity and specificity of 99mTc-HMPAO-leukocyte imaging in evaluating therapy result in patients with prosthetic joint infection (PJI) and in diagnosing suspected chronic PJI. METHODS: Sixty-two patients (63 joints) with microbiologically verified PJI were examined by leukocyte imaging to evaluate therapy result during or at the end of antibiotic treatment or if the patient had a chronic PJI after treatment. Group 1 consisted of 49 patients with on-going or within less than 14 days of ending antibiotic treatment examined to evaluate response. Group 2 consisted of 13 patients examined after completed treatment on suspicion of chronic PJI with no or recently initiated renewed antibiotic treatment. This study applied a combination of different imaging approaches of 99mTc-HMPAO-leukocyte scintigraphy: delayed and late planar images, bone marrow imaging and SPECT/CT imaging. All joints were examined with at least two of the approaches and 53 joints with all three approaches. The report was based on the combined results of the approaches used. A chronic PJI was confirmed with a positive microbiological culture. A cured infection was confirmed with either a negative culture or at least 24 months antibiotic-free follow-up with no relapse. RESULTS: In the therapy evaluation group sensitivity was 0.57 and specificity was 0.81. In the suspected chronic infection group sensitivity was 1.00 and specificity 0.91. CONCLUSIONS: 99mTc-HMPAO-leukocyte imaging appears to be an accurate method to diagnose or exclude chronic PJI, but cannot be recommended for therapy evaluation of PJI in patients with on-going antibiotic treatment.
BACKGROUND: To investigate the sensitivity and specificity of 99mTc-HMPAO-leukocyte imaging in evaluating therapy result in patients with prosthetic joint infection (PJI) and in diagnosing suspected chronic PJI. METHODS: Sixty-two patients (63 joints) with microbiologically verified PJI were examined by leukocyte imaging to evaluate therapy result during or at the end of antibiotic treatment or if the patient had a chronic PJI after treatment. Group 1 consisted of 49 patients with on-going or within less than 14 days of ending antibiotic treatment examined to evaluate response. Group 2 consisted of 13 patients examined after completed treatment on suspicion of chronic PJI with no or recently initiated renewed antibiotic treatment. This study applied a combination of different imaging approaches of 99mTc-HMPAO-leukocyte scintigraphy: delayed and late planar images, bone marrow imaging and SPECT/CT imaging. All joints were examined with at least two of the approaches and 53 joints with all three approaches. The report was based on the combined results of the approaches used. A chronic PJI was confirmed with a positive microbiological culture. A cured infection was confirmed with either a negative culture or at least 24 months antibiotic-free follow-up with no relapse. RESULTS: In the therapy evaluation group sensitivity was 0.57 and specificity was 0.81. In the suspected chronic infection group sensitivity was 1.00 and specificity 0.91. CONCLUSIONS: 99mTc-HMPAO-leukocyte imaging appears to be an accurate method to diagnose or exclude chronic PJI, but cannot be recommended for therapy evaluation of PJI in patients with on-going antibiotic treatment.
Authors: Brad Spellberg; Gloria Aggrey; Meghan B Brennan; Brent Footer; Graeme Forrest; Fergus Hamilton; Emi Minejima; Jessica Moore; Jaimo Ahn; Michael Angarone; Robert M Centor; Kartikeya Cherabuddi; Jennifer Curran; Kusha Davar; Joshua Davis; Mei Qin Dong; Bassam Ghanem; Doug Hutcheon; Philipp Jent; Minji Kang; Rachael Lee; Emily G McDonald; Andrew M Morris; Rebecca Reece; Ilan S Schwartz; Miranda So; Steven Tong; Christopher Tucker; Noah Wald-Dickler; Erica J Weinstein; Riley Williams; Christina Yen; Shiwei Zhou; Todd C Lee Journal: JAMA Netw Open Date: 2022-05-02
Authors: Karsten D Ottink; Stefan J Gelderman; Marjan Wouthuyzen-Bakker; Joris J W Ploegmakers; Andor W J M Glaudemans; Paul C Jutte Journal: J Bone Jt Infect Date: 2022-01-06
Authors: 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 Journal: Diagnostics (Basel) Date: 2022-03-10