ORIGINAL ARTICLE   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2020 March;64(1):85-95

DOI: 10.23736/S1824-4785.19.03040-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Is 99mTc-HMPAO-leukocyte imaging an accurate method in evaluating therapy result in prosthetic joint infection and diagnosing suspected chronic prosthetic joint infection?

Johan TEILER ^{1, 2} ✉, Marcus AHL ^{3, 4}, Börje ÅKERLUND ^{3, 4}, Sara WIRD ⁵, Harald BRISMAR ^{1, 6}, Annie BJÄREBACK ⁷, Håkan HEDLUND ^{1, 8}, Maria HOLSTENSSON ⁷, Rimma AXELSSON ^{1, 7}

¹ Department of Clinical Science, Technique and Intervention (CLINTEC), Karolinska Institute, Stockholm, Sweden; ² Abdominal Radiology, Karolinska University Hospital, Huddinge, Sweden; ³ Department of Medicine, Karolinska Institute, Stockholm, Sweden; ⁴ Unit of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; ⁵ Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden; ⁶ Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden; ⁷ Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; ⁸ Department of Orthopedic Surgery, Visby General Hospital, Visby, Sweden

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.

KEY WORDS: Leukocytes; Imaging; Single photon emission computed tomography computed tomography; Infection; Arthroplasty