Performance characteristics of 18F–fluorodeoxyglucose in non-infected hip replacement

Purpose The aim of this study was to retrospectively analyze 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/ computed tomography (CT) images of non-infected hip arthroplasty patients and summarize findings that may be useful for clinical practice. Methods 18F-FDG PET/CT images of non-infected hip arthroplasty patients were collected from September 2009 to August 2021. The region of interest was independently delineated by two physicians and maximum standardized uptake values (SUVmax) were recorded and compared. Serologic data were also collected and the correlation between SUVmax and serologic parameters was analyzed, while the images were classified based on the 18F-FDG uptake pattern in the images using the diagnostic criteria proposed by Reinartz et al. (9). The interval between hip replacement and PET/CT was classified by year and the characteristics of the two groups were compared. The images of patients who underwent PET/CT multiple times were analyzed dynamically. Results A total of 121 examinations were included; six patients underwent PET/CT twice and two patients had three scans. There were no significant correlations between SUVmax and serologic results. The interobserver agreement between the two physicians in the classification according to the criteria of Reinartz et al. (9) was 0.957 (P < 0.005). Although there was non-specific uptake in cases with an arthroplasty-to-PET/CT interval this was non-significant. Additionally, 18F-FDG showed potential utility for dynamic observation of the condition of the hip. Conclusion SUVmax provided information independent of serologic results, meanwhile 18F-FDG showed potential applicability to the dynamic monitoring of hip arthroplasty-related diseases. However, the presence of blood vessels and muscles affected image interpretation and the specificity of 18F-FDG was not optimal. A more specific radionuclide is needed to maximize the benefits of using PET/CT for the assessment of periprosthetic joint infection (PJI).

[1]  Jinming Zhang,et al.  Using 18F-flurodeoxyglucose and 68Ga-fibroblast activation protein inhibitor PET/CT to evaluate a new periprosthetic joint infection model of rabbit due to Staphylococcus aureus , 2021, Nuclear medicine communications.

[2]  Antonia F. Chen,et al.  Nuclear Medicine Scans in Total Joint Replacement. , 2020, The Journal of bone and joint surgery. American volume.

[3]  G. Kumar,et al.  Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria. , 2019, The bone & joint journal.

[4]  M. Vendelbo,et al.  18F FDG-PET/CT has poor diagnostic accuracy in diagnosing shoulder PJI , 2019, European Journal of Nuclear Medicine and Molecular Imaging.

[5]  R. Boellaard,et al.  18F-FDG-PET uptake in non-infected total hip prostheses , 2018, Acta orthopaedica.

[6]  R. Weijers,et al.  Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis , 2018, Acta radiologica.

[7]  J. Parvizi,et al.  The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. , 2018, The Journal of arthroplasty.

[8]  P. Raijmakers,et al.  The Accuracy of Imaging Techniques in the Assessment of Periprosthetic Hip Infection: A Systematic Review and Meta-Analysis. , 2016, The Journal of bone and joint surgery. American volume.

[9]  C. Hutchinson,et al.  Review of the role of dynamic 18F-NaF PET in diagnosing and distinguishing between septic and aseptic loosening in hip prosthesis , 2015, Journal of Orthopaedic Surgery and Research.

[10]  Mel S. Lee,et al.  Use of positron emission tomography to detect infection around antibiotic-loaded cement spacers in patients with high C-reactive protein levels. , 2011, Orthopedics.

[11]  J. Parvizi,et al.  New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society , 2011, Clinical orthopaedics and related research.

[12]  Tomoyuki Saito,et al.  Use of 18F-fluoride PET to determine the appropriate tissue sampling region for improved sensitivity of tissue examinations in cases of suspected periprosthetic infection after total hip arthroplasty , 2011, Acta orthopaedica.

[13]  T. Yen,et al.  Potential clinical role of 18F FDG-PET/CT in detecting hip prosthesis infection: a study in patients undergoing two-stage revision arthroplasty with an interim spacer. , 2010, The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of....

[14]  A. Alavi,et al.  FDG-PET Imaging Can Diagnose Periprosthetic Infection of the Hip , 2008, Clinical orthopaedics and related research.

[15]  A. Alavi,et al.  Comparison of fluorodeoxyglucose positron emission tomography and (111)indium-white blood cell imaging in the diagnosis of periprosthetic infection of the hip. , 2006, The Journal of arthroplasty.

[16]  P. Eysel,et al.  The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: Results from a prospective, blinded study , 2006, BMC musculoskeletal disorders.

[17]  D. Wirtz,et al.  Diagnostic values of positron emission tomography versus triple-phase bone scan in hip arthroplasty loosening , 2005, Archives of Orthopaedic and Trauma Surgery.

[18]  U. Cremerius,et al.  Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. , 2005, The Journal of bone and joint surgery. British volume.

[19]  K. Nichols,et al.  Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[20]  Thomas F Hany,et al.  FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. , 2004, Radiology.

[21]  H. Kundel,et al.  Measurement of observer agreement. , 2003, Radiology.

[22]  U. Cremerius,et al.  Fluordeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty. , 2003, The Journal of arthroplasty.

[23]  A. Alavi,et al.  Applications of fluorodeoxyglucose positron emission tomography in the diagnosis of infection , 2003, Nuclear medicine communications.

[24]  A. Alavi,et al.  Rapid normalization of osseous FDG uptake following traumatic or surgical fractures , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[25]  J. Nuyts,et al.  The value of 18FDG-PET for the detection of infected hip prosthesis , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[26]  A. Alavi,et al.  The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses , 2002, Nuclear medicine communications.

[27]  A. Alavi,et al.  Persistent non-specific FDG uptake on PET imaging following hip arthroplasty , 2002, European Journal of Nuclear Medicine and Molecular Imaging.

[28]  K. Hahn,et al.  The use of [18F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses , 2002, Nuclear medicine communications.

[29]  A. Alavi,et al.  The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants. , 2001, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[30]  Pugliese,et al.  5. Utility of F-18 FDG Imaging for Diagnosing the Infected Joint Replacement. , 2000, Clinical positron imaging : official journal of the Institute for Clinical P.E.T.

[31]  M. Leok.  The use of , 1996 .

[32]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.