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Weissman BN, Palestro CJ, Fox MG, Bell AM, Blankenbaker DG, Frick MA, Jawetz ST, Kuo PH, Said N, Stensby JD, Subhas N, Tynus KM, Walker EA, Kransdorf MJ. ACR Appropriateness Criteria® Imaging After Total Hip Arthroplasty. J Am Coll Radiol 2023; 20:S413-S432. [PMID: 38040462 DOI: 10.1016/j.jacr.2023.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | | | - Angela M Bell
- Rush University Medical Center, Chicago, Illinois; American College of Physicians
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | - Phillip H Kuo
- University of Arizona, Tucson, Arizona; Commission on Nuclear Medicine and Molecular Imaging
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Katherine M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
| | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
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2
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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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3
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Thurston D, Hurley P, Raheel F, James S, Gadvi R, Botchu R, Gardner AC, Mehta JS. A Comparison of Magnetic Resonance Imaging and SPECT-CT Imaging in Complex Spine Pathology: Does SPECT-CT Provide Additional Diagnostic Information Over Magnetic Resonance Imaging? Global Spine J 2023:21925682231163812. [PMID: 36939636 DOI: 10.1177/21925682231163812] [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: 03/21/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Magnetic Resonance Imaging (MRI) is often regarded as the gold standard for spinal pathology, as it provides good structural visualisation. SPECT-CT, however, provides combined structural and functional information. There is a paucity of literature comparing SPECT-CT with MRI in the spine. Our aim was to determine whether SPECT-CT provides additional information to MRI in individuals with complex spinal pathology, including deformity, which altered management. METHODS We conducted a retrospective review of all individuals seen at our tertiary spinal unit that were investigated with both MRI and SPECT-CT of the spine between 2007-2020. We reviewed imaging reports, and collated diagnoses, surgical treatment and the relative contributions of MRI and SPECT-CT to management decisions. RESULTS 104 individuals identified, with a mean age of 30 years (89 females and 15 males). Diagnostic categories were adolescent, adult, and congenital deformity, degenerative pathology, and miscellaneous pathology. MRI returned positive findings in 58 (55.8%), and SPECT-CT in 41 (39.4%) cases. SPECT-CT identified 10 cases of facet joint degeneration, 5 of increased uptake around metalwork suggestive of loosening, 1 pseudoarthrosis, 1 partial failure of fusion and 1 osteoid osteoma which were not reported on MRI, all in individuals who had previously undergone spinal instrumentation. Despite this, SPECT-CT only altered management for 6 individuals (5.8%). CONCLUSIONS MRI is less useful in the setting of previous instrumentation due to metal artefact. Where MRI is inconclusive, particularly in individuals with previous spinal instrumentation, SPECT-CT may provide a diagnosis, but is not recommended as primary imaging.
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Affiliation(s)
- Daniel Thurston
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Patrick Hurley
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Falaq Raheel
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Steven James
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rakesh Gadvi
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adrian C Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jwalant S Mehta
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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4
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Palestro CJ. Molecular Imaging of Periprosthetic Joint Infections. Semin Nucl Med 2023; 53:167-174. [PMID: 36496268 DOI: 10.1053/j.semnuclmed.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Infection is an infrequent complication of lower extremity prosthetic joint surgery. Approximately one third develop within 3 months (early), another third within 1 year (delayed), and the remainder more than 1 year (late) after surgery. The diagnosis of periprosthetic joint infection is not always straightforward. Pain, the most common symptom, is present in 90%-100% of patients. The presence of fever is more variable, ranging from less than 5% to more than 40% of patients with infection. Erythema and joint swelling are often present in acute infections, but are less common in chronic infections. Erythrocyte sedimentation rate, C-reactive protein and interleukin-6 levels are useful "rule out" tests, while peripheral blood leukocyte count and serum tumor necrosis factor α are not helpful. The diagnosis of periprosthetic joint infection often requires a combination of blood, synovial fluid, and tissue sample tests, as well as imaging. Plain radiographs lack sensitivity and specificity. Molecular imaging is useful for evaluating painful joint replacements. Bone scintigraphy is most useful as a screening test. If it is negative then infection and aseptic loosening are unlikely. Combined labeled leukocyte/bone marrow imaging is a very specific test for diagnosing lower extremity joint arthroplasty infection; sensitivity is more variable. Despite more than two decades of investigation, there still is no consensus on the value of 18F-FDG for diagnosing periprosthetic joint infection. Differing test probabilities, an inability to discriminate between infection and inflammation secondary to physiologic reactions, and lack of standardized interpretative criteria are obstacles to incorporating 18F-FDG into the routine diagnostic imaging workup of periprosthetic joint infection. Preliminary results for gallium-68 citrate, fluorine-18, and technetium-99m labeled antimicrobial fragments are encouraging but no large scale trials with these agents have been conducted. Limited data suggest that labeled leukocyte/bone marrow SPECT/CT and 18F-FDG-PET/CT are specific but not sensitive for diagnosing periprosthetic infection of shoulder arthroplasties. There are minimal data on molecular imaging for monitoring treatment response in periprosthetic infections.
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Pierce JL, Perry MT, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Banks J, Caracciolo JT, DeGeorge KC, Demertzis JL, Garner HW, Scott JA, Sharma A, Beaman FD. ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update. J Am Coll Radiol 2022; 19:S473-S487. [PMID: 36436971 DOI: 10.1016/j.jacr.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Musculoskeletal infections involve bones, joints, and soft tissues. These infections are a common clinical scenario in both outpatient and emergent settings. Although radiography provides baseline findings, a multimodality approach is often implemented to provide more detailed information on the extent of infection involvement and complications. MRI with intravenous contrast is excellent for the evaluation of musculoskeletal infections and is the most sensitive for diagnosing osteomyelitis. MRI, CT, and ultrasound can be useful for joint and soft tissue infections. When MRI or CT is contraindicated, bone scans and the appropriate utilization of other nuclear medicine scans can be implemented for aiding in the diagnostic imaging of infection, especially with metal hardware and arthroplasty artifacts on MRI and CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Jennifer L Pierce
- University of Virginia, Charlottesville, Virginia; Associate Division Chair, Musculoskeletal Radiology, University of Virginia; Radiology Residency Global Health Leadership Track Program Director, University of Virginia.
| | - Michael T Perry
- Research Author, University of Virginia Health Center, Charlottesville, Virginia
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- The Johns Hopkins University School of Medicine, Baltimore, Maryland; member
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri; MSK Imaging and Interventions Fellowship Director, Mallinckrodt Institute of Radiology
| | - James Banks
- Aventura Hospital, Aventura, Florida; Student Radiology Rotation Clerkship Director for HCA Florida Aventura and Kendall Hospitals; Nova Southeastern University, Fort Lauderdale, Florida
| | - Jamie T Caracciolo
- Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee; Section Head, MSK Imaging, Moffitt Cancer Center; Chairman, ACR MSK-RADS Committee
| | - Katharine C DeGeorge
- University of Virginia, Charlottesville, Virginia; Primary care physician; Deputy Editor, DynaMed; and Advisory Board, Flo Health Medical
| | - Jennifer L Demertzis
- Diagnostic Imaging Associates, Chesterfield, Missouri; Partner, ProSight Radiology
| | - Hillary W Garner
- Mayo Clinic Florida, Jacksonville, Florida; Committee Chair, Society of Skeletal Radiology and International Skeletal Society
| | - Jinel A Scott
- SUNY Downstate Health Sciences University, Brooklyn, New York; Chief Quality Officer
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging; Chair, Research Committee, Radiology, Mayo Clinic Florida; PET-MRI workgroup, Mayo Clinic Florida
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Ding Y, Feng D, Liu Y, Gao J, Wang L, Li Y, Guo Y, Tang F. The prevalence and risk factors of dislocation after primary total hip arthroplasty. Acta Orthop Belg 2022; 88:467-474. [PMID: 36791699 DOI: 10.52628/88.3.9760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This study aimed to investigate the occurrence of dislocation and risk factors following primary total hip arthroplasty (THA). Retrospective analysis was done on the clinical data of 441patients with primary total hip arthroplasty who were admitted to our hospital between May 2018 and early December 2020. A total of 294 patients without posterior soft tissue repair were included as control group, and a total of 147 patients with repair of the short external rotator muscle and joint capsule were assigned to the repair group. All operated patients were observed to analyze the occurrence and risk of early postoperative dislocation. Within 6 months after hip arthroplasty, the early hip dislocation rate in the repair group was 0.68%, which was significantly lower than that in the control group (4.78%) (P < 0.05). The results of multifactorial analysis showed that age ≥75 years, combined limb or mental illness, artificial femoral head diameter <30 mm, posterolateral approach and prosthesis placement outside the safety zone, and improper handling were risk factors for dislocation (P < 0.05); The incidence of re-dislocation was lower in the targeted intervention group (P < 0.05). The occurrence of dislocation after THA is related to age, gender, and type of orthopedic disease. The risk factors should be explored to develop targeted intervention protocol, decreasing the dislocation rate and improving the prognosis.
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Burke CJ, Khodarahmi I, Fritz J. Postoperative MR Imaging of Joints. Magn Reson Imaging Clin N Am 2022; 30:583-600. [DOI: 10.1016/j.mric.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy. J Clin Med 2022; 11:jcm11154416. [PMID: 35956033 PMCID: PMC9369831 DOI: 10.3390/jcm11154416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Abstract
Hip arthroplasty (HA) is a frequently used procedure with high success rates, but 7% to 27% of the patients complain of persistent postsurgical pain 1 to 4 years post-operation. HA complications depend on the post-operative delay, the type of material used, the patient’s characteristics, and the surgical approach. Radiographs are still the first imaging modality used for routine follow-up, in asymptomatic and painful cases. CT and MRI used to suffer from metallic artifacts but are nowadays central in HA complications diagnosis, both having their advantages and drawbacks. Additionally, there is no consensus on the optimal imaging workup for HA complication diagnosis, which may have an impact on patient management. After a brief reminder about the different types of prostheses, this article reviews their normal and pathologic appearance, according to each imaging modality, keeping in mind that few abnormalities might be present, not anyone requiring treatment, depending on the clinical scenario. A diagnostic imaging workup is also discussed, to aid the therapist in his imaging studies prescription and the radiologist in their practical aspects.
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Aleksyniene R, Iyer V, Bertelsen HC, Nilsson MF, Khalid V, Schønheyder HC, Larsen LH, Nielsen PT, Kappel A, Thomsen TR, Lorenzen J, Ørsted I, Simonsen O, Jordal PL, Rasmussen S. 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; 12:diagnostics12030681. [PMID: 35328234 PMCID: PMC8947521 DOI: 10.3390/diagnostics12030681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023] Open
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.
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Affiliation(s)
- Ramune Aleksyniene
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
- Correspondence: ; Tel.: +45-41416038
| | - Victor Iyer
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
- Department of Radiology and Molecular Medicine, University Hospital Uppsala, 75237 Uppsala, Sweden
| | - Henrik Christian Bertelsen
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
| | - Majbritt Frost Nilsson
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (V.I.); (H.C.B.); (M.F.N.)
| | - Vesal Khalid
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark; (V.K.); (S.R.)
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.C.S.); (L.H.L.)
| | - Lone Heimann Larsen
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.C.S.); (L.H.L.)
| | - Poul Torben Nielsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Andreas Kappel
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Trine Rolighed Thomsen
- Center for Microbial Communities, Aalborg University, 9220 Aalborg, Denmark;
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Jan Lorenzen
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Iben Ørsted
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Ole Simonsen
- Interdisciplinary Orthopaedics, Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.T.N.); (A.K.); (O.S.)
| | - Peter Lüttge Jordal
- Danish Technology Institute, Medical Biotechnology, 8000 Aarhus, Denmark; (J.L.); (P.L.J.)
| | - Sten Rasmussen
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark; (V.K.); (S.R.)
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark
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10
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Gamma camera imaging (bone scan) in orthopedics: Foot, ankle, knees, and hip. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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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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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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Gao Z, Jin Y, Chen X, Dai Z, Qiang S, Guan S, Li Q, Huang J, Zheng J. Diagnostic Value of MRI Lamellated Hyperintense Synovitis in Periprosthetic Infection of Hip. Orthop Surg 2020; 12:1941-1946. [PMID: 33225607 PMCID: PMC7767676 DOI: 10.1111/os.12789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/17/2023] Open
Abstract
Objective To investigate the correlation between magnetic resonance imaging (MRI) lamellated hyperintense synovitis and periprosthetic infection of hip arthroplasty and estimate its value in the diagnosis of infection after hip replacement. Methods A retrospective analysis of 50 patients who underwent MRI from January 2016 to June 2019 after hip replacement was performed. The MRI scanning was performed with a 1.5T clinical imaging unit using SEMAC protocols. A total of 25 patients (cohort 1) showed infected total hip arthroplasty, and 25 patients had non‐infected arthroplasty as controls (cohort 2). Two musculoskeletal radiologists, blinded to the clinical diagnosis, reviewed all the images for the presence of lamellated hyperintense synovitis independently. The cases were rereviewed by each reader after 2 weeks. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the first reads. The Kappa statistic was used to assess inter‐observer and intra‐observer reliability. Results The incidence of lamellated hyperintense synovitis was 76%–88% in the experimental group and 8%–16% in the control group. The sensitivity of lamellated hyperintense synovitis for infection was 0.80–0.88 (95% confidence interval [CI]:0.59 – 0.97), the specificity was 0.84~0.92 (95% CI: 0.64 –0.99), the positive predictive value 0.83–0.92 (95% CI: 0.67 – 0.98), the negative predictive value 0.81 – 0.88 (95% CI: 0.65 – 0.96). The agreement between two readers was substantial (Kappa = 0.76, 95% CI: 0.58 – 0.94, P < 0.05). There were moderate inter–observer agreements for both readers, reader 1 (Kappa = 0.48, 95%CI: 0.23 – 0.72, P < 0.05) and reader 2 (Kappa = 0.44,95% CI: 0.19 – 0.69, P < 0.05). Conclusion In this cohort, the presence of lamellated hyperintense synovitis in the MRI of hip arthroplasty showed high sensitivity and specificity for infection. This sign had substantial intra‐observer reliability and moderate inter‐observer reliability in the classification of the synovial pattern.
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Affiliation(s)
- Zongyan Gao
- Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Yi Jin
- Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Xiao Chen
- Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Zhipeng Dai
- Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Shuo Qiang
- Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Shuyuan Guan
- Department of Medical Imaging, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Qiang Li
- Department of Medical Imaging, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Jincheng Huang
- Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
| | - Jia Zheng
- Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China
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14
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Schuldt A, Lehnick D, Agten CA, Beck M, Kist M, Bhure U, Del Sol Pérez Lago M, Strobel K. Performance of radiography and single-photon emission computed tomography/computed tomography in painful total hip arthroplasty and impact on arthroplasty survival. Nucl Med Commun 2020; 41:875-882. [PMID: 32796475 DOI: 10.1097/mnm.0000000000001244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the performance of radiography and single-photon emission computed tomography/computed tomography (SPECT/CT) in painful hip arthroplasty regarding loosening and arthroplasty survival. METHODS Radiography and SPECT/CT reports of 249 painful hip arthroplasties of 191 patients were reviewed. Positive imaging was defined if loosening, infection, and polyethylene wear were found, indicating the need for arthroplasty exchange. Median time from radiograph to operation or last follow-up was 41.3 months (range 0.3-118.4 months). In 67 patients, the performance of radiographs and SPECT/CT regarding loosening was compared with an intraoperative reference standard. The time point of arthroplasty exchange was compared with imaging diagnosis and evaluated with Kaplan-Meier curves. RESULTS Exchange of cup, shaft, or both was performed in 76 of 249 arthroplasties. Main diagnoses on SPECT/CT were loosening (n = 94), infection (n = 5), and polyethylene wear (n = 15). In total, 104 patients were SPECT/CT positive compared to 84 patients on radiography. Five-year survival of arthroplasties for radiograph positive and negative arthroplasties was 41.5%/83.4% and 39.3%/90.7% for SPECT/CT, respectively. Prognostic impact regarding arthroplasty exchange was highest in radiograph and SPECT/CT concordant positive patients (hazard ratio 19.7 as compared to radiograph and SPECT/CT negative patients). Sensitivity and specificity in 67 operated patients regarding shaft loosening were 59.4%/80.0% with radiography, 90.6%/68.6% with SPECT/CT (P = 0.002 for sensitivity and P = 0.29 for specificity), and for cup loosening 47.4%/89.6% with radiography and 63.2%/85.4% with SPECT/CT (P = 0.51, respectively, P = 0.63). CONCLUSION In patients with painful hip arthroplasty, positive radiography, and SPECT/CT are associated with poorer arthroplasty survival. Performance regarding loosening is slightly better with SPECT/CT.
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Affiliation(s)
- Anna Schuldt
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
| | - Dirk Lehnick
- Biostatistics and Methodology, University of Lucerne
| | | | - Martin Beck
- Orthopaedic Surgery and Traumatology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Markus Kist
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
| | - Ujwal Bhure
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
| | | | - Klaus Strobel
- Radiology and Nuclear Medicine, Cantonal Hospital Lucerne
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15
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Computed Tomography (CT) Protocols Associated with Cardiac and Bone Single-Photon Emission Computed Tomography/CT (SPECT/CT) in Korea. Nucl Med Mol Imaging 2020; 54:139-146. [PMID: 32582397 DOI: 10.1007/s13139-020-00644-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Single-photon emission computed tomography/computed tomography (SPECT/CT) is an advanced hybrid nuclear medicine technology that generates both functional and anatomical images in a single study. As utilization of SPECT/CT in Korea has been increasing, the purpose of this study was to survey its application of cardiac and skeletal SPECT/CT imaging for protocol optimization. METHODS We surveyed CT protocols established for cardiac and skeletal SPECT/CT. We searched the guidelines for the CT protocols for SPECT/CT and reviewed the literature recently published. RESULTS Among 36 hybrid SPECT scanners equipped with four or more multi-channel detector CTs (MDCTs), 18 scanners were used to perform cardiac studies at both very low current CT (30-80 mA; 11.1%) and ultra-low current CT (13-30 mA; 88.9%). Among the 33 canners, very low current (≤ 80 mA) CT or low current CT (80-130 mA) was used in 23.5%, and 41.8% for spine disorders, and in 36.4% or 30.3% for foot/ankle disorders, respectively. In the CT reconstructions, slice thickness of 5 mm for cardiac studies was most commonly used (94.4%); thinner slices (0.6-1.0 mm) for spine and foot/ankle studies were used in 24.2% and 45.5%, respectively. We also reviewed the international guidelines. CONCLUSIONS The results and current recommendations will be helpful for optimizing CT protocols for SPECT/CT. Optimization of SPECT/CT protocols will be required for generating the proper strategy for the specific lesions and clinical purpose.
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