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Puijk R, Lubbe P, Sierevelt IN, Kristians AE, Boer J, Nolte PA. The Diagnostic Characteristic and Reproducibility of Bone Scintigraphy Single-Photon Emission Computed Tomography/Computed Tomography for Diagnosing Aseptic Loosening of Uncemented Total Knee Arthroplasty. J Arthroplasty 2024; 39:1707-1713.e1. [PMID: 38218556 DOI: 10.1016/j.arth.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The primary objective of this study was to investigate the diagnostic characteristics of bone scintigraphy single-photon emission computed tomography/computed tomography (BS-SPECT/CT) for diagnosing aseptic loosening after uncemented total knee arthroplasty (TKA), and to evaluate the following aspects: how to manage inconclusive results, the interobserver reliability, and the location of tracer uptake between symptomatic cases with and without aseptic loosening. METHODS In this study, 180 patients who had uncemented TKA and persistent knee pain suspected of aseptic loosening were included. As part of routine medical care, BS-SPECT/CT was used, and its results were compared with the reference standard, which involved revision surgery for aseptic loosening or a 12-month follow-up without revision or imaging. Inconclusive BS-SPECT/CT results were considered either negative (best-case scenario) or positive (worst-case scenario). Sensitivity, specificity, positive/negative likelihood ratios (LRs), and positive/negative predictive values (PPV and NPV) were calculated. Sensitivity analyses were conducted by comparing the diagnostic characteristics between cases with a follow-up of less and more than 2 years of follow-up. The anatomical distribution of tracer uptake and interobserver reliability were also evaluated. RESULTS Of the 180 BS-SPECT/CT scans conducted, 22 were determined positive, 113 negative, and 45 inconclusive. The best-case scenario showed a sensitivity of 66.7%, specificity of 93.8%, +LR 10.8, -LR 0.4, PPV 54.6%, and NPV 96.2%. In contrast, the worst-case scenario had a sensitivity of 94.4%, specificity of 69.1%, +LR 3.1, -LR 0.1, PPV 25.4%, and NPV 99.1%. Sensitivity analyses revealed no relevant differences in characteristics between the 2 TKA-interval groups. The interobserver reliability was fair-to-moderate (κ = 0.39; 95% confidence interval 0.18 to 0.60), with an estimated agreement of 79% (95% confidence interval 70 to 87). Four prosthetic zones had a notably higher proportion of cases with tracer uptake in those with aseptic loosening compared to those without. CONCLUSIONS The test characteristics of BS-SPECT/CT were deemed appropriate in patients who have complaints of uncemented TKA suspected of aseptic loosening. Inconclusive cases were best categorized as negative, especially in patients who have a short interval between TKA and the first BS-SPECT/CT. Increased tracer uptake in 4 prosthetic zones was observed in cases of aseptic loosening, although interobserver reliability was fair to moderate. LEVEL OF EVIDENCE Level III, Diagnostic Retrospective Cohort Study.
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Affiliation(s)
- Raymond Puijk
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Pieter Lubbe
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands; Orthopedic Department, Xpert Clinics, Amsterdam, The Netherlands
| | - Angela E Kristians
- Department of Medical Nuclear Imaging, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Jouke Boer
- Department of Medical Nuclear Imaging, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands; Department of Oral Cell Biology, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Buijs GS, Kooijenga AC, Rikken QGH, Schafroth MU, Kievit AJ, Blankevoort L. MRI and SPECT/CT demonstrate, with low certainty of evidence, the highest diagnostic accuracy for aseptic knee arthroplasty loosening: A systematic comparative diagnostic test review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38769774 DOI: 10.1002/ksa.12206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE The purpose of this study was to evaluate and compare the diagnostic accuracy of modalities used to aid the diagnosis of aseptic knee arthroplasty loosening. METHODS A comparative diagnostic test accuracy systematic review and meta-analysis was conducted following the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE and Cochrane databases were searched for original articles evaluating diagnostic modalities up to March 2024. Included studies compared the modality (index test) to the intraoperative finding as reference test. The QUADAS-C (Quality Assessment of Diagnostic Accuracy Studies-Comparative) tool was used to assess the quality of the included studies. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to evaluate the certainty of evidence. Level of evidence was evaluated using the Oxford Levels of Evidence tool. The primary outcome was the summary of diagnostic accuracy metrics for each modality as demonstrated by a summary receiver-operating characteristic (SROC) curve. RESULTS The search yielded 467 articles. Of these, 14 articles were included. These 14 articles evaluated a total of five different diagnostic modalities: bone scintigraphy (three studies, 146 cases), 18-fluorodeoxyglucose positron emission tomography (two studies, 50 cases), single-photon emission computed tomography combined with computed tomography (SPECT/CT) (seven studies, 371 cases), radionuclide arthrogram (three studies, 196 cases) and magnetic resonance imaging (MRI) (one study, 116 cases). Nine studies exhibited a high risk of bias in patient selection, and all studies showed a high risk of bias related to the reference test. The majority of the included studies were classified as Level III evidence, leading to an overall low level of certainty in the evidence. The most accurate tests, as demonstrated by the SROC analysis, were MRI and SPECT/CT, with sensitivities ranging from 0.00 to 1.00 and 0.33 to 1.00 and specificities between 0.31-1.00 and 0.00-1.00, respectively. CONCLUSIONS This review and meta-analysis evaluated available diagnostic modalities to aid the diagnosis of knee arthroplasty loosening and based on a low certainty of evidence suggests that MRI and SPECT/CT are currently the most accurate modalities available to aid the diagnosis of aseptic loosening of knee arthroplasty components. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- George S Buijs
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Anne C Kooijenga
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Quinten G H Rikken
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Arthur J Kievit
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery and Sport Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
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Richter A, Stukenborg-Colsman C, Plaass C. SPECT/CT of Total Ankle Arthroplasty. Foot Ankle Clin 2023; 28:493-507. [PMID: 37536815 DOI: 10.1016/j.fcl.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.
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Affiliation(s)
- Alena Richter
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany
| | - Christina Stukenborg-Colsman
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany
| | - Christian Plaass
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany.
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Anzola LK, Hernandez N, Rodriguez LF, Sanguino G, Martinez E, Lopez R, Moreno S, Prill R, Mut F, Rasch H, Hirschmann M. The role of SPECT/CT in painful, noninfected knees after knee arthroplasty: a systematic review and meta-analysis-a diagnostic test accuracy review. J Orthop Surg Res 2023; 18:223. [PMID: 36945001 PMCID: PMC10031962 DOI: 10.1186/s13018-023-03687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE The aim of this systematic review was to present the current evidence on the clinical use of single-photon emission computed tomography/computed tomography (SPECT/CT) in the evaluation of noninfected painful knees after knee arthroplasty. METHODS Embase, PubMed, Google Scholar, Ovid, Scopus, Science Direct and the Cochrane Database of Systematic Reviews were searched from database inception to May 2022 following the PRISMA guidelines. As a primary outcome, we defined the role of SPECT/CT in the diagnostic approach to noninfected painful knee arthroplasty; as a secondary objective, we described the noninfection-related factors linked to painful knee arthroplasty. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio values and other indicators were calculated; receiver operating characteristic (ROC) curve analysis results and a summary of the areas under the curve (AUCs) from the included studies were reported. A Fagan plot, likelihood ratio plot and Deeks' funnel plot were generated and analysed. Methodological quality was assessed using the QUADAS-2 tool, and the certainty of evidence was assessed by the GRADE approach. RESULTS A total of 493 publications were identified, of which eight met the inclusion criteria, with a final pooled sample size of 308 patients. The pooled sensitivity and specificity of SPECT/CT in diagnosing the source of pain in painful knee prostheses were 0.86 (95% CI: 0.75-0.93) and 0.90 (95% CI: 0.79-0.96), respectively, with pooled +LR and -LR values of 8.9 (95% CI: 4.11-19.19) and 0.15 (95% CI: 0.09-0.28). The pooled diagnostic odds ratio was 57.35, and the area under the curve was 0.94. SPECT/CT highly accurately identified different sources of pain, such as loosening of the prosthetic components, patellofemoral overloading, instability, malalignment of the components and degeneration of the patellofemoral compartment. The confidence of the estimates was moderate according to the GRADE approach. CONCLUSION With demonstrated high sensitivity and specificity, as a diagnostic tool, SPECT/CT can identify the source of pain in painful knees after knee arthroplasty, particularly in cases of loosening, patellofemoral disorders and component malalignment (level of evidence III). These findings have significant clinical repercussions, such as in changing the initial diagnosis, identifying or excluding different causes of painful knee arthroplasties, guiding subsequent treatment and positively impacting the final clinical outcome. We moderately recommend the use of SPECT/CT for identifying the source of pain after knee arthroplasty according to the GRADE assessment. This review was preregistered in Prospero under code CRD42022320457.
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Affiliation(s)
- Luz Kelly Anzola
- Department of Nuclear Medicine, Clinica Reina Sofia, Bogota, Colombia.
- Department of Nuclear Medicine, Clinica Colombia, Bogota, Colombia.
- Fundacion Universitaria Sanitas Nuclear Medicine Postgraduate Program, Bogota, Colombia.
| | - Nathaly Hernandez
- Fundacion Universitaria Sanitas Nuclear Medicine Postgraduate Program, Bogota, Colombia
| | | | - Gilberto Sanguino
- Department of Orthopedics and Traumatology, Clinica Reina Sofia, Bogota, Colombia
| | - Ernesto Martinez
- Department of Orthopedics and Traumatology, Clinica Reina Sofia, Bogota, Colombia
| | - Rodrigo Lopez
- Department of Orthopedics and Traumatology, Clinica Reina Sofia, Bogota, Colombia
| | - Sergio Moreno
- Clinical Epidemiologist, Universidad Nacional de Colombia, Bogota, Colombia
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel, Brandenburg Medical School Theodore Fontane, Neuruppin, Germany
| | - Fernando Mut
- Department of Nuclear Medicine, Hospital Italiano, Montevideo, Uruguay
| | - Helmut Rasch
- Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Michael Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
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Elrod RW, Pelt CE, Mason JB, Volkmar AJ, Polkowksi GG, Coronado RA, Martin JR. Could Novel Radiographic Findings Help Identify Aseptic Tibial Loosening? J Arthroplasty 2023:S0883-5403(23)00051-7. [PMID: 36716899 DOI: 10.1016/j.arth.2023.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/17/2022] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Aseptic loosening following total knee arthroplasty remains one of the leading causes of long-term failure. Radiographic identification of loose implants can be challenging with standard views. The purpose of this study was to compare the incidence of novel radiographic findings of anterior heterotopic bone formation and medial or lateral cyst formation in patients who have aseptic loosening to patients who have well-fixed implants. METHODS A retrospective radiographic review was performed on 48 patients' revised secondary to aseptic tibial loosening. This cohort was compared to two additional cohorts; 48 patients returning for routine postoperative follow-up (control 1), and 48 patients revised secondary to infection or instability who had well-fixed implants (control 2). RESULTS There were 41 of 48 (85%) patients who had implant loosening and were noted to have anterior heterotopic bone formation compared to 1 of 48 (2%) patients in control 1 and 3 of 48 (6%) patients in control 2 (P ≤ .0001). There were 43 of 48 (90%) patients who had implant loosening and had medial cyst formation compared to 3 of 48 (6%) patients in control 1 and 5 of 48 (10%) in control 2 (P ≤ .0001). There were 42 of 48 (88%) patients who had implant loosening and had lateral cyst formation compared to 2 of 48 (4%) patients in control 1 and 4 of 48 (8%) in control 2 (P ≤ .0001). CONCLUSION In this study, we describe novel radiographic findings of anterior heterotopic bone formation and cysts that develop in patients who have aseptic loosening following primary total knee arthroplasty. We believe that these radiographic features may lead to easier identification of aseptic loosening.
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Affiliation(s)
- Robert W Elrod
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, Utah
| | - J Bohannan Mason
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Alexander J Volkmar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory G Polkowksi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rogelio A Coronado
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Endo Y, Burge AJ, Koff MF, Lin B, Westrich GH, Boettner F, Chiu YF, Potter HG. Diagnostic Performance of MRI for Component Loosening in Total Knee Arthroplasty Compared with Radiography. Radiology 2022; 304:128-136. [PMID: 35315718 DOI: 10.1148/radiol.204458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Because loosening of total knee arthroplasty (TKA) occurs due to poor osseous integration at component-bone interfaces, interface assessment may be helpful in diagnosing loosening at MRI. Purpose To determine interreader reproducibility for characterizing component interfaces and diagnosing loosening and to evaluate the diagnostic performance of MRI for diagnosing loosening after TKA compared with radiography. Materials and Methods Consecutive knees with TKA that underwent revision between July 2018 and June 2019 and were imaged at MRI and radiography were included in this retrospective study. Interface type (normal, fibrous membrane, fluid, or osteolysis), percent integration (<33%, 33%-66%, or >66%), and presence of bone marrow edema pattern were assessed. Loosening was diagnosed at MRI if no or almost no normal interface was present. Sensitivity and specificity were compared with radiographs by using surgical findings as reference. Gwet agreement coefficient evaluated interreader reproducibility between two readers and multivariable logistic regression assessed risk factors for loosening. Results Among 116 knees in 114 patients (mean age, 63 years ± 10 [SD]; 59 women), 61 of 116 knees (52.6%) had at least one loose component. Interreader reproducibility of MRI was substantial to excellent (Gwet agreement coefficient, 0.67-0.96). Loosening was associated with fluid interface (odds ratio [OR], 20.1; 95% CI: 5.7, 70.9) or osteolysis (OR, 3.1; 95% CI: 1.8, 5.3), absence of any normal interface (OR, 11.8; 95% CI: 6.3, 22.2), poor (<33%) osseous integration (OR, 20.4; 95% CI: 9.7, 42.6), and bone marrow edema pattern (OR, 4.7; 95% CI: 2.8, 7.8). Sensitivity and specificity of MRI for loosening were 84% (27 of 32; 95% CI: 72, 97) and 85% (71 of 84; 95% CI: 77, 92) for the patellar, 31% (eight of 26; 95% CI: 13, 49) and 100% (90 of 90; 95% CI: 100, 100) for the femoral, and 81% (22 of 27; 95% CI: 66, 96) and 98% (87 of 89; 95% CI: 95, 100) for the tibial component, respectively. MRI had higher sensitivity (84% vs 31%; P < .001) but lower specificity (85% vs 96%; P = .003) for patellar component loosening than did radiography, respectively, whereas no evidence of a difference was found for femoral (sensitivity and specificity, MRI vs radiography: 31% vs 46% [P = .20] and 100% vs 99% [P > .99], respectively) or tibial (sensitivity and specificity, MRI vs radiography: 81% vs 70% [P = .16] and 98% vs 97% [P = .32], respectively) component loosening. Conclusion MRI demonstrated substantial to excellent interreader reproducibility and higher sensitivity than did radiography for diagnosing patellar component loosening after total knee arthroplasty. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Yoshimi Endo
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Alissa J Burge
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Matthew F Koff
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Bin Lin
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Geoffrey H Westrich
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Friedrich Boettner
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Yu-Fen Chiu
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
| | - Hollis G Potter
- From the Department of Radiology and Imaging (Y.E., A.J.B., M.F.K., B.L., H.G.P.), Department of Orthopedic Surgery (G.H.W., F.B.), and Biostatistics Core, Research Administration (Y.F.C.), Hospital for Special Surgery, 535 E 70th St, New York, NY 10021
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Peng Z, Jia Y, Li J, Wang G. Diagnostic Performance of Single-Photon Emission Computed Tomography/Computed Tomography in Aseptic Loosening: A Systematic Review and Meta-Analysis. J Arthroplasty 2021; 36:4003-4012.e3. [PMID: 34275709 DOI: 10.1016/j.arth.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the diagnostic value and clinical applicability of single-photon emission computed tomography/computed tomography (SPECT/CT) in aseptic loosening (AL) of prostheses by meta-analysis. METHOD Literature on the diagnostic value of SPECT/CT in AL of prostheses was obtained by computer and manual review. The quality of the included studies was evaluated according to the Quality Assessment Diagnostic Accuracy Studies 2. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and other indicators were calculated, and a forest map and summary receiver operating characteristic were drawn to calculate the area under the curve. Meta-regression analysis was performed to identify the sources of heterogeneity and corresponding subgroup analysis was performed. A Fagan plot, likelihood ratio point plot, and Deek's funnel plot were drawn and analyzed. RESULTS A total of 15 studies were included. The meta-analysis results showed that the pooled sensitivity and specificity of SPECT/CT for the diagnosis of aseptic prosthetic loosening were 0.94, 95% confidence interval [CI] (0.90-0.96) and 0.89, 95% CI (0.78-0.95), respectively while the pooled positive likelihood ratio and pooled negative likelihood ratio were 8.65, 95% CI (4.18-17.90) and 0.07, 95% CI (0.04-0.11), respectively. The pooled diagnostic odds ratio was 130.36, 95% CI (45.18-376.19), and the area under the curve was 0.97, 95% CI (0.95-0.98). CONCLUSION As a diagnostic method for AL, SPECT/CT has high diagnostic sensitivity and specificity as well as high diagnostic efficiency. It has good clinical application value and should be a primary choice in the diagnosis of AL after joint replacement.
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Affiliation(s)
- Zhan Peng
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
| | - Yukun Jia
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
| | - Jin Li
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
| | - Guangye Wang
- Department of Orthopaedic Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University, Shenzhen, People's Republic of China; Clinical Teaching Department, the Second School of Clinical Medicine, Southern Medical University, Shenzhen, People's Republic of China
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Koppula BR, Morton KA, Al-Dulaimi R, Fine GC, Damme NM, Brown RKJ. SPECT/CT in the Evaluation of Suspected Skeletal Pathology. ACTA ACUST UNITED AC 2021; 7:581-605. [PMID: 34698290 PMCID: PMC8544734 DOI: 10.3390/tomography7040050] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 01/16/2023]
Abstract
Dedicated multi-slice single-photon emission computed tomography/computed tomography (SPECT/CT) cameras have become widely available and are becoming a mainstay of clinical practice. The integration of SPECT and CT allow for precise anatomic location of scintigraphic findings. Fusion imaging with SPECT/CT can improve both sensitivity and specificity by reducing equivocal interpretation in comparison to planar scintigraphy or SPECT alone. This review article addresses the technique, basic science principles, and applications of integrated SPECT/CT in the evaluation of musculoskeletal pathology.
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Bao B, Liu CS, Masson ECO, Abele JT. Diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic joint prostheses loosening. Eur J Hybrid Imaging 2021; 5:4. [PMID: 34181120 PMCID: PMC8218161 DOI: 10.1186/s41824-021-00098-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic prosthesis loosening following hip and knee arthroplasty. Methods A retrospective review of 63 SPECT/CT arthrogram studies (36 knees and 27 hips) between February 1, 2013, and July 1, 2018, was conducted. All patients underwent clinical and radiologic evaluation as part of their assessment for persistent pain following hip and knee arthroplasty. The detection of tracer activity along the bone-prosthetic interface on SPECT/CT suggests aseptic loosening. Operative assessment as well as clinical/radiologic follow-up at a minimum of 1 year was used as the reference standard. Results The sensitivity and specificity of SPECT/CT for detection of aseptic loosening was 6/7 (86%) and 55/56 (98%), respectively. This gives a positive predictive value (PPV) of 6/7 (86%), a negative predictive value (NPV) of 55/56 (98%), and a diagnostic accuracy of 61/63 (97%). Conclusion SPECT/CT arthrography has a high diagnostic accuracy (97%) in the evaluation of loosening of both hip and knee arthroplasties in patients with persistent post-procedural pain.
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Affiliation(s)
- Bo Bao
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 Walter C Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2B7, Canada.
| | - Crystal S Liu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Edward C O Masson
- Division of Orthopedic Surgery, University Alberta, Edmonton, Alberta, Canada
| | - Jonathan T Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 Walter C Mackenzie Health Sciences Centre, Edmonton, Alberta, T6G 2B7, Canada
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Abstract
» A 3-phase bone scan is a potential first-line nuclear medicine study for pain after total joint arthroplasty (TJA) when there is concern for periprosthetic joint infection or aseptic loosening. » In patients who have a positive bone scintigraphy result and suspected infection of the joint, but where aspiration or other studies are inconclusive, labeled leukocyte scintigraphy with bone marrow imaging may be of benefit. » Magnetic resonance imaging (MRI), while not a nuclear medicine study, also shows promise and has the advantage of providing information about the soft tissues around a total joint replacement. » Radiotracer uptake patterns in scintigraphy are affected by the prosthesis (total knee arthroplasty [TKA] versus total hip arthroplasty [THA]) and the use of cement. » Nuclear medicine scans may be ordered 1 year postoperatively but may have positive findings that are due to normal physiologic bone remodeling. Nuclear studies may be falsely positive for up to 2 years after TJA. » Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) (SPECT/CT), fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT, and MRI show promise; however, more studies are needed to better define their role in the diagnostic workup of pain after TJA.
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Affiliation(s)
- John M Pinski
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel M Estok
- Department of Orthopedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph J Kavolus
- Department of Orthopedic Surgery, Tufts Medical Center, Boston, Massachusetts
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Clinical usefulness of single photon emission tomography/computed tomography with stress analysis in early diagnoses of stem instability of noncemented hip arthroplasty. Nucl Med Commun 2020; 42:244-252. [PMID: 33306622 DOI: 10.1097/mnm.0000000000001323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Hip pain arising from implant instability is generally caused by repetitive stress injury, which subsequently leads to induction or exacerbation of abnormal metabolism of bone around the implant. single photon emission tomography/computed tomography (SPECT-CT) has advantages in localizing areas of increased tracer uptake that reflects such abnormal bone metabolism. Therefore, we investigated whether the application of SPECT/CT with stress analysis can be an effective practice in evaluating the instability of stem in noncemented hip arthroplasty or not. METHOD In total 16 patients were collected for unexplained painful hip arthroplasties. When physical examination and blood tests were unremarkable, radiographs were inconclusive and bone scan indicated increased scintigraphic uptake at the proximal part and at the tip of the stem; SPECT/CT was performed. Stem stability was assessed by measuring whether there was consistency between the increased scintigraphic uptake and the direction of the stress around the implant along with the location of the prosthesis. RESULT Among the 16 symptomatic hips, 9 hips showed the stability of the stem, 3 hips showed the stem instability and 4 hips showed the acetabular loosening with the stem stability. With the application of SPECT/CT with stress analysis, 15 out of 16 (93.7%) cases were found to have the change in the diagnoses, and managements were implemented in 11 out of 16 (68.7%) cases. When comparing before and after SPECT/CT, there was no significant association in clinical diagnosis and management (Pearson chi- square test = 4.61 and 1.33, P = 0.33 and 0.25). CONCLUSION SPECT/CT combined with stress analysis can be a useful tool in early diagnosis of stem instability and can assist surgeons in subsequent management and decision implementation when other radiographic imagings are inconclusive.
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Kienzle A, Walter S, von Roth P, Fuchs M, Winkler T, Müller M. High Rates of Aseptic Loosening After Revision Total Knee Arthroplasty for Periprosthetic Joint Infection. JB JS Open Access 2020; 5:JBJSOA-D-20-00026. [PMID: 32984749 PMCID: PMC7480970 DOI: 10.2106/jbjs.oa.20.00026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
With increasing life expectancy, the demand for knee replacement is continuously rising. Despite the use of antibiotic prophylaxis and improved aseptic surgical techniques, periprosthetic joint infection (PJI) still occurs in 1% to 5% of patients after primary arthroplasty. An open question is the influence of PJI and resulting surgical procedures on the occurrence of long-term complications such as aseptic loosening. Patients needing multiple revision surgeries are especially at risk for decreases in bone mass and damage to the medullary cavity. Thus, we theorized that prior surgeries on the affected knee increase the risk of aseptic loosening in patients with PJI.
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Affiliation(s)
- Arne Kienzle
- Center for Musculoskeletal Surgery, Clinic for Orthopedics and Traumatology, Charité University Hospital Berlin, Berlin, Germany.,Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sandy Walter
- Center for Musculoskeletal Surgery, Clinic for Orthopedics and Traumatology, Charité University Hospital Berlin, Berlin, Germany
| | | | - Michael Fuchs
- RKU University Department of Orthopedics, University of Ulm, Ulm, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery, Clinic for Orthopedics and Traumatology, Charité University Hospital Berlin, Berlin, Germany
| | - Michael Müller
- Center for Musculoskeletal Surgery, Clinic for Orthopedics and Traumatology, Charité University Hospital Berlin, Berlin, Germany
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Murer AM, Hirschmann MT, Amsler F, Rasch H, Huegli RW. Bone SPECT/CT has excellent sensitivity and specificity for diagnosis of loosening and patellofemoral problems after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:1029-1035. [PMID: 31263926 DOI: 10.1007/s00167-019-05609-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/26/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE The primary purpose of this retrospective study with prospectively collected data was to evaluate the clinical value of SPECT/CT, in particular its impact on clinical diagnosis and patient management, in patients with pain, stiffness, or swelling after primary total knee arthroplasty (TKA). The secondary purpose was to determine the sensitivity and the specificity of SPECT/CT for different pathologies such as loosening and patellofemoral overloading. METHODS A retrospective analysis was carried out on 214 knees in 202 consecutive patients (mean age 69 ± 11 years) with persistent or recurrent knee pain after TKA. All patients underwent clinical examination, standardised radiographs, and 99mTc-hydroxymethane diphosphonate (HDP) SPECT/CT as part of a routine diagnostic algorithm. The diagnoses before and after SPECT/CT and final treatment were recorded. TKA component position was routinely measured on 3D-reconstructed images. Intensity and anatomical distribution of bone tracer uptake were determined. RESULTS SPECT/CT changed the clinical diagnosis and final treatment in 139/214 (65%) knees. In 117 (54.7%) out of 214 patients, revision surgery was proposed following SPECT/CT. Early onset of pain was significantly (p = 0.011) correlated with tibiofemoral stress pattern in SPECT/CT. A total of 86 knees (40.2%) were surgically revised using semi-constrained or fully constrained TKA. In 35 patients, a secondary patellar resurfacing was performed. SPECT/CT showed the clinical diagnosis to be incorrect for suspicion of tibial component loosening in 56 patients (26.2%), femoral component loosening in 53 patients (24.8%), and patellofemoral overloading/progressive patellofemoral osteoarthritis in 26 patients (12.1%) and provided different underlying causes of persistent knee pain after TKA. Likewise, SPECT/CT identified tibial component loosening in 8 patients (3.7%), femoral component loosening in 4 patients (1.9%), and patellofemoral OA in 71 patients (33.2%) without prior clinical suspected diagnosis. The sensitivity and specificity of SPECT/CT for detection of patellofemoral OA was 96.5% and 96.2%, respectively. The sensitivity and specificity for detection of tibial component loosening was 96.0% and 100%, respectively. The sensitivity and specificity for detection of femoral component loosening was 95.0% and 100%, respectively. CONCLUSION The diagnostic benefits of SPECT/CT in the challenging and complex cohort of patients with pain after primary TKA have been proven. The excellent sensitivity and specificity for detection of tibial or femoral component loosening and diagnosis of patellofemoral OA have been surgically confirmed. Due to the benefits in establishing the correct diagnosis, SPECT/CT should be implemented as part of the routine diagnostic algorithm for patients with pain after primary TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Andreas M Murer
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
- University of Basel, Basel, Switzerland.
| | | | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
| | - Rolf W Huegli
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
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Barnsley L, Barnsley L. Detection of aseptic loosening in total knee replacements: a systematic review and meta-analysis. Skeletal Radiol 2019; 48:1565-1572. [PMID: 30976835 DOI: 10.1007/s00256-019-03215-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/26/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare the diagnostic accuracy of nuclear imaging modalities in the detection of aseptic loosening of total knee arthroplasty (TKA). MATERIALS AND METHODS MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from database inception to December 2018 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies compared the results of a single imaging modality against an appropriate reference standard of prosthetic TKA loosening, with sufficient information to determine either sensitivity and/or specificity. The methodological quality of the studies was assessed using the QUADAS-2 tool. RESULTS The search strategy identified 572 abstracts. Of these, 12 studies comprising 401 patients across four modalities (bone scintigraphy, 18F-FDG-PET, SPECT/CT arthrogram, radionuclide arthrogram) met the inclusion criteria. All included studies used operative findings, a period of clinical or radiographic observation or both as a reference standard for aseptic loosening. Sixteen comparisons with the reference standards were extracted. All studies were at risk of bias across patient selection, the index test, reference standard, and flow and timing of patients. The most accurate test for diagnosis of aseptic loosening in TKA was SPECT/CT arthrography demonstrated by the summary receiver operating characteristic curve. CONCLUSIONS The best available evidence suggests the most accurate modality for the detection of aseptic loosening in TKA is SPECT/CT arthrography. However, the available evidence has a high risk of bias, and total number of patients studied for each modality is small so further studies are warranted.
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Affiliation(s)
- Lara Barnsley
- Orthopaedic Department, Western Health, 160 Gordon Street, Footscray, Victoria, 3011, Australia.
| | - Les Barnsley
- Department of Medicine, University of Sydney, Sydney, Australia.,Department of Rheumatology, Concord Hospital, Hospital Rd, Concord, NSW, 2139, Australia
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van der Bruggen W, Hirschmann MT, Strobel K, Kampen WU, Kuwert T, Gnanasegaran G, Van den Wyngaert T, Paycha F. SPECT/CT in the Postoperative Painful Knee. Semin Nucl Med 2018; 48:439-453. [PMID: 30193650 DOI: 10.1053/j.semnuclmed.2018.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review summarizes the role of SPECT/CT in patients with a painful postoperative knee and describes typical diagnostic criteria in these patients. Pain after knee surgery is common and is influenced by the underlying pathology, the type of surgery, and the patient. Knee joint-preserving surgery includes osteotomy, ligament reconstruction, meniscus surgery, and cartilage repair procedures, often used in combination. Knee arthroplasty procedures consist of unicondylar, patellofemoral, and primary or revision total knee prosthesis. In patients with pain after knee joint-preserving surgery, MRI remains the reference standard. After ligament reconstruction, CT can evaluate postoperative tunnel positioning, and bone SPECT/CT can contribute by assessing overloading or biodegradation problems. After meniscal or cartilage surgery, SPECT/CT can be particularly helpful to identify compartment overloading or nonhealing chondral or osteochondral lesions as cause of pain. SPECT/CT arthrography can assess cartilage damage at an early stage due to altered biomechanical forces. After corrective osteotomy of the knee, SPECT/CT can reveal complications such as overloading, nonunion, or patellofemoral problems. After arthroplasty, conventional radiographs lack both sensitivity to detect aseptic loosening and specificity in differentiating aseptic from infectious loosening. Secondly, hardware-induced artifacts still hamper CT and MRI, despite improving and increasingly available metal artifact reduction techniques. Bone scintigraphy is a proven useful adjunct to conventional radiography and MRI to reveal the pain generator and is less hampered by artifacts from metallic implants compared with CT and MRI. Nevertheless, the optimal imaging strategy in evaluating complications after knee arthroplasty is still a matter of debate. Although the evidence of the use of BS SPECT/CT is still limited, it is growing steadily. In particular, recent data on specific uptake patterns in tibial and femoral zones after total knee arthroplasty and the impact of integrating biomechanics into the assessment of SPECT/CT appear promising, but more research is needed.
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Affiliation(s)
- Wouter van der Bruggen
- Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands..
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Gopinath Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Frédéric Paycha
- Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Van den Wyngaert T, Paycha F, Strobel K, Kampen WU, Kuwert T, van der Bruggen W, Gnanasegaran G. SPECT/CT in Postoperative Painful Hip Arthroplasty. Semin Nucl Med 2018; 48:425-438. [PMID: 30193649 DOI: 10.1053/j.semnuclmed.2018.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Consecutive milestones in hip arthroplasty design and surgical technique have contributed to the successful and cost-effective intervention this procedure has become today in maintaining mobility and quality of life in patients with osteoarthritis, fracture, or other hip conditions. With the increasing prevalence of hip joint replacements, the need for improved diagnostic imaging tools to guide revision surgery has risen in parallel. Over the last few years, promising data have emerged on the potential role of bone SPECT/CT imaging in the assessment of patients with recurrent pain after arthroplasty. This review summarizes the trends in hip arthroplasty surgery (partial vs total arthroplasty; cemented vs cementless arthroplasty; resurfacing arthroplasty) and prosthesis design (bearing materials; stem designs) over the last decade. In particular, the impact on the biomechanics and interpretation of bone SPECT/CT findings is discussed, with emphasis on integrative reporting in the following frequently encountered conditions: lysis/aseptic loosening, septic loosening, heterotopic ossification, periprosthetic fracture, tendinopathies, and adverse local tissue reactions. Based on the available literature data, bone SPECT/CT is increasingly being used as second-line imaging modality when conventional investigations are nondiagnostic. Further outcome research is warranted to examine whether this technique could be used earlier in patient management.
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Affiliation(s)
- Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium..
| | - Frédéric Paycha
- Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Wouter van der Bruggen
- Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands
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17
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Mohan HK, Strobel K, van der Bruggen W, Gnanasegaran G, Kampen WU, Kuwert T, Van den Wyngaert T, Paycha F. The role of hybrid bone SPECT/CT imaging in the work-up of the limping patient: a symptom-based and joint-oriented review. Eur J Hybrid Imaging 2018; 2:8. [PMID: 29782592 PMCID: PMC5954706 DOI: 10.1186/s41824-018-0026-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022] Open
Abstract
A vast spectrum of lower limb bone and joint disorders (hip, knee, ankle, foot) present with a common clinical presentation: limping. Too often this symptom generates an inefficient cascade of imaging studies. This review attempts to optimise the diagnostic effectiveness of bone scintigraphy using the hybrid SPECT/CT technique in relation to the diagnostic clues provided by other imaging modalities, discusses the appropriate clinical indications, optimal scintigraphic procedures and illustrates updated image pattern-oriented reporting. Frequent lower limb bone and joint pathologies that can now be reliably diagnosed using hybrid bone SPECT/CT imaging will be reviewed. Bone SPECT/CT can be an effective problem-solving tool in patients with persistent limping when careful history taking, clinical examination, and first-line imaging modalities fail to identify the underlying cause.
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Affiliation(s)
- H K Mohan
- Department of Nuclear Medicine, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - K Strobel
- 2Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - W van der Bruggen
- 3Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands
| | - G Gnanasegaran
- 4Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - W U Kampen
- Nuclear Medicine Spitalerhof, Hamburg, Germany
| | - T Kuwert
- 6Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - T Van den Wyngaert
- 7Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.,8Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - F Paycha
- 9Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
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18
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Tang H, Yang D, Guo S, Tang J, Liu J, Wang D, Zhou Y. Digital tomosynthesis with metal artifact reduction for assessing cementless hip arthroplasty: a diagnostic cohort study of 48 patients. Skeletal Radiol 2016; 45:1523-32. [PMID: 27589968 DOI: 10.1007/s00256-016-2466-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/13/2016] [Accepted: 08/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES For postoperative imaging assessment of cementless hip arthroplasty, radiography and computed tomography (CT) were restricted by overlapping structures and metal artifacts, respectively. A new tomosynthesis with metal artifact reduction (TMAR) is introduced by using metal extraction and ordered subset-expectation maximization (OS-EM) reconstruction. This study investigated the effectiveness of TMAR in assessing fixation stability of cementless hip arthroplasty components. MATERIALS AND METHODS We prospectively included 48 consecutive patients scheduled for revision hip arthroplasty in our hospital, with 41 femoral and 35 acetabular cementless components available for evaluation. All patients took the three examinations of radiography, CT, and TMAR preoperatively, with intraoperative mechanical tests, and absence or presence of osteointegration on retrieved prosthesis as reference standards. Three senior surgeons and four junior surgeons evaluated these images independently with uniform criteria. RESULTS For TMAR, 82 % diagnoses on the femoral side and 84 % diagnoses on the acetabular side were accurate. The corresponding values were 44 and 67 % for radiography, and 39 % and 74 % for CT. Senior surgeons had significantly higher accuracy than junior surgeons by radiography (p < 0.05), but not by TMAR or CT. CONCLUSIONS By minimizing metal artifacts in the bone-implant interface and clearly depicting peri-implant trabecular structures, the TMAR technique improved the diagnostic accuracy of assessing fixation stability of cementless hip arthroplasty, and shortened the learning curve of less experienced surgeons. LEVEL OF EVIDENCE Level II, diagnostic cohort study.
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Affiliation(s)
- Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Shengjie Guo
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Jing Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Jian Liu
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Dacheng Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China.
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