Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis

作者：Kwee Robert M^*; Broos Wouter A M; Brans Boudewijn; Walenkamp Geert H I M; Geurts Jan; Weijers Rene E

来源：Acta Radiologica, 2018, 59(5): 569-576.

DOI：10.1177/0284185117726812

• Prosthesis
• arthroplasty
• hip joint
• infection
• 18-fluoro-deoxyglucose positron emission tomography (18F-FDG PET)

Background: The diagnosis of infected hip prosthesis is frequently not straightforward yet very important as it changes treatment.
Purpose: To retrospectively investigate the added value of 18F-FDG PET/CT to conventional tests including radiography, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) testing, and joint aspiration, in diagnosing infected hip prosthesis.
Material and Methods: Seventy-eight hip prostheses of 78 patients (55% men; mean age = 66.5 years; age range = 30-85 years) with non-specific clinical presentation, i.e. no abscess or sinus tract communicating with the joint space at clinical examination, were analyzed. Cultures of intra-articular fluid and peri-implant tissues after revision surgery or clinical follow-up 6 months served as gold standard. Areas under the receiver operating characteristic curves (AUCs) of radiography, ESR/CRP testing, aspiration culture, and white blood cell (WBC) count without and with the addition of 18F-FDG PET/CT were compared.
Results: The addition of 18F-FDG PET/CT increased AUCs: for radiography with 0.212, P = 0.001; for ESR/CRP testing with 0.076, P = 0.072; for aspiration culture with 0.126, P = 0.032; and for aspiration WBC count with 0.191, P = 0.035.
Conclusion: This study shows that 18F-FDG PET/CT adds to individual conventional tests in diagnosing infected hip prosthesis. It may improve the preoperative planning and should therefore be considered in the diagnostic work-up. Future studies should define the exact place of 18F-FDG PET/CT in the diagnostic work-up of periprosthetic joint infection.

• 出版日期2018-5