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The value of 18FDG-PET for the detection of infected hip prosthesis

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Abstract

We compared the accuracy of fluorine-18 labelled 2-fluoro-2-deoxy-d-glucose positron emission tomography (18FDG PET) with that of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (LS) in the detection of infected hip prosthesis. Seventeen patients with a hip prosthesis suspected for infection were prospectively included and underwent 99mTc-methylene diphosphonate bone scintigraphy (BS), LS and an 18FDG-PET scan within a 2-week period. Seven volunteers with ten asymptomatic hip prostheses were used as a control group and underwent BS and an 18FDG-PET scan. Bacteriology of samples obtained by surgery or by needle aspiration and/or clinical follow-up for up to 6 months were used as the gold standard. Planar images of BS and LS (4 and 24 h p.i.) were acquired, followed by single-photon emission tomography (SPET) LS images (after 4 h). These images were scored as positive or negative by two experienced readers. The 18FDG-PET scans of the patients were compared with the tracer distribution pattern in the asymptomatic control group and with BS. A phantom study was performed in order to identify artefacts. For this purpose, three different attenuation correction methods were tested. The combined analysis of the planar BS and LS resulted in a 75% sensitivity and a 78% specificity. The SPET LS images showed a better lesion contrast, resulting in an 88% sensitivity and a 100% specificity, while 24-h planar images were of no additional value. The analysis of PET images alone resulted in an 88% sensitivity and a 78% specificity. The combination of 18FDG-PET and BS images resulted in an 88% sensitivity and a 67% specificity. Given the presence of small errors near the edge of the metal, which can induce significant artefacts in the corrected emission image, we decided to use the data without attenuation correction. In this preliminary study, 18FDG-PET scans alone showed the same sensitivity as combined BS and LS, although the specificity was slightly lower.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium

    Benedicte Vanquickenborne, Alex Maes, Johan Nuyts, Frank Van Acker & Luc Mortelmans

  2. Orthopedic Surgery, University Hospital Pellenberg, Katholieke Universiteit, Leuven, Belgium

    Jos Stuyck & Michiel Mulier

  3. Laboratoryium for Radiopharmaceutical Chemistry, University Hospital Gasthuisberg, Leuven, Belgium

    Alfons Verbruggen

Authors
  1. Benedicte Vanquickenborne
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  2. Alex Maes
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  3. Johan Nuyts
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  4. Frank Van Acker
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  5. Jos Stuyck
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  6. Michiel Mulier
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  7. Alfons Verbruggen
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  8. Luc Mortelmans
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Correspondence to Luc Mortelmans.

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Vanquickenborne, B., Maes, A., Nuyts, J. et al. The value of 18FDG-PET for the detection of infected hip prosthesis. Eur J Nucl Med Mol Imaging 30, 705–715 (2003). https://doi.org/10.1007/s00259-002-1109-6

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  • DOI: https://doi.org/10.1007/s00259-002-1109-6

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