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Teiler J, Ahl M, Åkerlund B, Brismar H, Holstensson M, Gabrielson S, Hedlund H, Axelsson R. 99mTc-HMPAO-WBC SPECT/CT versus 18F-FDG-WBC PET/CT in chronic prosthetic joint infection: a pilot study. Nucl Med Commun 2022; 43:193-200. [PMID: 34678830 DOI: 10.1097/mnm.0000000000001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare 99mTc-HMPAO-WBC-SPECT/CT combined with 99mTc-nanocollloid SPECT/CT and 18F-FDG-WBC-PET/CT combined with 99mTc-Nanocollloid SPECT/CT for the diagnosis and treatment evaluation of chronic prosthetic joint infection (PJI). METHODS Patients with suspected chronic PJI were examined with 99mTc-HMPAO-WBC SPECT/CT, 18F-FDG-WBC PET/CT, and 99mTc-nanocolloid SPECT/CT (to visualize bone marrow). The location and patterns of uptake were noted and compared between the two leukocyte examinations. Both leukocyte examinations were evaluated visually for infection. The PET examinations were also evaluated semiquantitatively. Chronic PJI was verified clinically by microbial culture and successfully treated PJI was confirmed by 12 months symptom-free follow-up after cessation of antibiotics. RESULTS Nineteen patients were included with 10 hip prostheses and nine knee prostheses. Fourteen were diagnosed with chronic PJI and five with successfully treated PJI. The sensitivity of visual evaluation of 99mTc-WBC-HMPAO SPECT/CT for all joints was 0.31 and for 18F-FDG-WBC PET/CT 0.38. The specificity was 0.80 and 0.83, respectively. All patients with a true-positive SPECT examination had a false-negative PET examination and vice versa. Semiquantitative evaluation of the hips gave an area under the curve of 0.905 using the iliac crest as the background. Semiquantitative evaluation of the knees did not produce significant results. CONCLUSION This pilot study showed no difference in the sensitivity or specificity of 99mTc-HMPAO-WBC SPECT/CT and 18F-FDG-WBC PET/CT when combined with 99mTc-nanocollloid SPECT/CT in the diagnosis or treatment evaluation of suspected late chronic PJI.
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Affiliation(s)
- Johan Teiler
- Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
- Department of Radiology, Karolinska University Hospital, Huddinge
| | - Marcus Ahl
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Unit of Infectious Diseases, Karolinska University Hospital, Huddinge
| | - Börje Åkerlund
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm
- Unit of Infectious Diseases, Karolinska University Hospital, Huddinge
| | - Harald Brismar
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
- Department of Orthopaedic Surgery, Karolinska University Hospital, Huddinge
| | - Maria Holstensson
- Functional Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
- Function Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Stefan Gabrielson
- Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
- Radiology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Håkan Hedlund
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
- Department of Orthopaedic Surgery, Visby Hospital, Visby, Sweden
| | - Rimma Axelsson
- Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
- Functional Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
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Teiler J, Åkerlund B, Brismar H, Savitcheva I, Ahl M, Bjäreback A, Hedlund H, Holstensson M, Axelsson R. Dual-tracer approach vs. dual time-point approach in leukocyte scintigraphy in treatment evaluation of persistent chronic prosthetic joint infection. Nucl Med Commun 2021; 42:719-724. [PMID: 33741868 PMCID: PMC8191474 DOI: 10.1097/mnm.0000000000001403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both dual time-point 99mTc-hexamethylpropylene amine oxime (HMPAO)-leukocyte scintigraphy and dual-tracer 99mTc-HMPAO-leukocyte scintigraphy (with the addition of 99mTc-nanocolloid bone marrow scintigraphy) have been used to diagnose prosthetic joint infection (PJI). A treatment evaluation of persistent PJI using these imaging protocols has yet to be presented. OBJECTIVE The purpose of this study was to compare the accuracy of dual time-point 99mTc-HMPAO-leukocyte scintigraphy to the dual-tracer alternative of single time-point 99mTc-HMPAO-leukocyte scintigraphy or single-photon emission computed tomography/computed tomography (SPECT/CT) combined with a 99mTc-nanocolloid bone marrow scintigraphy or SPECT/CT, for treatment evaluation of PJI. MATERIAL AND METHODS Thirty-one PJI patients under antibiotic treatment were included in this retrospective study. Examinations were organized into three settings. Setting one used dual time-point approach with delayed (2 h) and late (24 h) planar 99mTc-HMPAO-leukocyte scintigraphy, including both visual and semiquantitative analysis. Setting two used delayed (2 h) planar 99mTc-HMPAO-leukocyte scintigraphy combined with 99mTc-nanocolloid bone marrow scintigraphy and for setting three SPECT/CT replaced planar imaging. RESULTS Accuracy was 0.68 for visual evaluation and 0.55 for semiquantitative evaluation of setting one; 0.71 for setting two; and 0.68 for setting three. Sensitivity was 0.54 for visual evaluation and 0.31 for semiquantitative evaluation of setting one; 0.38 for setting two; and 0.46 for setting three. Specificity was 0.78 for visual evaluation and 0.72 for semiquantitative evaluation of setting one; 0.94 for setting two; and 0.83 for setting three. CONCLUSION No significant difference in accuracy, sensitivity, or specificity between the approaches for treatment evaluation of suspected persistent PJI in the hip or knee was observed.
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Affiliation(s)
- Johan Teiler
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institutet
- Department of Radiology, Karolinska University Hospital Huddinge
| | - Börje Åkerlund
- Department of Medicine, Karolinska Institutet
- Unit of Infectious Diseases Karolinska University Hospital Huddinge
| | - Harald Brismar
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institutet
- Department of Orthopaedic Surgery, Karolinska University Hospital Huddinge
| | - Irina Savitcheva
- Function Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital Huddinge
| | - Marcus Ahl
- Department of Medicine, Karolinska Institutet
- Unit of Infectious Diseases Karolinska University Hospital Huddinge
| | - Annie Bjäreback
- Function Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital Huddinge
| | - Håkan Hedlund
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institutet
- Department of Orthopaedic Surgery, Visby General Hospital, Stockholm, Sweden
| | - Maria Holstensson
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institutet
- Function Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital Huddinge
| | - Rimma Axelsson
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institutet
- Function Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital Huddinge
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Karalli A, Teiler J, Haji M, Seth E, Brismar TB, Wahlin S, Axelsson R, Stål P. Comparison of lipiodol infusion and drug-eluting beads transarterial chemoembolization of hepatocellular carcinoma in a real-life setting. Scand J Gastroenterol 2019; 54:905-912. [PMID: 31287338 DOI: 10.1080/00365521.2019.1632925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: Doxorubicin-eluting beads transarterial chemoembolization (DEB-TACE) is reported to improve survival and tolerability when compared with conventional lipiodol-TACE (cTACE) for the treatment of hepatocellular carcinoma (HCC). The aim of this study was to evaluate tolerability and long-term survival in patients treated with cTACE or DEB-TACE in a real-life setting. Methods: Incidence of adverse events and overall survival in HCC patients treated with either cTACE or DEB-TACE at Karolinska University Hospital 2004-2012 were analyzed retrospectively. Median follow-up was 7.1 years. Patients were censored when transplanted or at the end of follow-up. Patients receiving both cTACE and DEB-TACE, or treated with resection or ablation post-TACE were excluded from the survival analysis. Results: A total of 202 patients (76 cTACE and 126 DEB-TACE) were eligible for analysis of adverse events, and 179 patients (69 cTACE and 110 DEB-TACE) were included in the survival analysis. cTACE patients were younger and had fewer tumors but higher BCLC stage than DEB-TACE. Child-Pugh and ECOG performance status were similar between groups. Adverse events (abdominal pain, nausea and vomiting, fever, fatigue) were significantly less common in the DEB-TACE group. Median survival was 17.1 months in the cTACE group and 19.1 months in the DEB-TACE (NS). In multivariate Cox regression analysis, portal vein thrombosis and tumor size were associated with increased, and sorafenib treatment post-TACE with decreased mortality. Conclusion: In this retrospective real-life analysis, DEB-TACE had better tolerability compared to cTACE, but overall survival did not differ between the two treatments. Portal vein thrombosis, tumor size and sorafenib treatment after TACE influence survival.
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Affiliation(s)
- Amar Karalli
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden
| | - Johan Teiler
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden
| | - Mojgan Haji
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden
| | - Elin Seth
- Department of Clinical Science and Education, Karolinska Institutet South Hospital , Stockholm , Sweden
| | - Torkel B Brismar
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden
| | - Staffan Wahlin
- Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden.,Unit of Liver Diseases, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital , Stockholm , Sweden
| | - Rimma Axelsson
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet , Stockholm , Sweden.,Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital , Huddinge , Sweden
| | - Per Stål
- Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet , Stockholm , Sweden.,Unit of Liver Diseases, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital , Stockholm , Sweden
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Teiler J, Ahl M, Åkerlund B, Wird S, Brismar H, Bjäreback A, Hedlund H, Holstensson M, Axelsson R. Is 99mTc-HMPAO-leukocyte imaging an accurate method in evaluating therapy result in prosthetic joint infection and diagnosing suspected chronic prosthetic joint infection? Q J Nucl Med Mol Imaging 2019; 64:85-95. [PMID: 31140233 DOI: 10.23736/s1824-4785.19.03040-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND To investigate the sensitivity and specificity of 99mTc-HMPAO-leukocyte imaging in evaluating therapy result in patients with prosthetic joint infection (PJI) and in diagnosing suspected chronic PJI. METHODS Sixty-two patients (63 joints) with microbiologically verified PJI were examined by leukocyte imaging to evaluate therapy result during or at the end of antibiotic treatment or if the patient had a chronic PJI after treatment. Group 1 consisted of 49 patients with on-going or within less than 14 days of ending antibiotic treatment examined to evaluate response. Group 2 consisted of 13 patients examined after completed treatment on suspicion of chronic PJI with no or recently initiated renewed antibiotic treatment. This study applied a combination of different imaging approaches of 99mTc-HMPAO-leukocyte scintigraphy: delayed and late planar images, bone marrow imaging and SPECT/CT imaging. All joints were examined with at least two of the approaches and 53 joints with all three approaches. The report was based on the combined results of the approaches used. A chronic PJI was confirmed with a positive microbiological culture. A cured infection was confirmed with either a negative culture or at least 24 months antibiotic-free follow-up with no relapse. RESULTS In the therapy evaluation group sensitivity was 0.57 and specificity was 0.81. In the suspected chronic infection group sensitivity was 1.00 and specificity 0.91. CONCLUSIONS 99mTc-HMPAO-leukocyte imaging appears to be an accurate method to diagnose or exclude chronic PJI, but cannot be recommended for therapy evaluation of PJI in patients with on-going antibiotic treatment.
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Affiliation(s)
- Johan Teiler
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institute, Stockholm, Sweden - .,Abdominal Radiology, Karolinska University Hospital, Huddinge, Sweden -
| | - Marcus Ahl
- Department of Medicine, Karolinska Institute, Stockholm, Sweden.,Unit of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Börje Åkerlund
- Department of Medicine, Karolinska Institute, Stockholm, Sweden.,Unit of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Wird
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Harald Brismar
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Annie Bjäreback
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Håkan Hedlund
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Department of Orthopedic Surgery, Visby General Hospital, Visby, Sweden
| | - Maria Holstensson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rimma Axelsson
- Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institute, Stockholm, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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