Comparison of Fluorodeoxyglucose Positron Emission Tomography and 111Indium–White Blood Cell Imaging in the Diagnosis of Periprosthetic Infection of the Hip

Pill, Stephen G.; Parvizi, Javad; Tang, Peter H.; Garino, Jonathan P.; Nelson, Charles; Zhuang, Hongming; Alavi, Abass

doi:10.1016/j.arth.2006.05.021

« Previous Next »The Journal of Arthroplasty
Volume 21, Issue 6, Supplement , Pages 91-97, September 2006

Comparison of Fluorodeoxyglucose Positron Emission Tomography and ¹¹¹Indium–White Blood Cell Imaging in the Diagnosis of Periprosthetic Infection of the Hip

Stephen G. Pill, MD
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
Javad Parvizi, MD
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
- Rothman Institute of Orthopedics at Thomas Jefferson University, Philadelphia, Pennsylvania
- Reprint requests: Javad Parvizi, MD, Rothman Institute of Orthopedics at Thomas Jefferson Hospital, 925 Chestnut Street, Fifth Floor, Philadelphia, PA 19107.
Peter H. Tang, BA
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jonathan P. Garino, MD
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
Charles Nelson, MD
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
Hongming Zhuang, MD
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Abass Alavi, MD
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Received 26 January 2006; accepted 15 May 2006.

Abstract

We aimed to compare the accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) with technetium-99m sulfur colloid ¹¹¹indium-labeled white blood cell scintigraphy (TcSC-Ind BM/WBC) in diagnosis of periprosthetic infection. Eighty-nine patients with 92 painful hip prostheses were recruited prospectively and given the option of undergoing either combined FDG-PET and TcSC-Ind BM/WBC or FDG-PET only. FDG-PET correctly diagnosed 20 of the 21 infected cases (sensitivity, 95.2%) and ruled out infection in 66 of the 71 aseptic hips (specificity, 93%) corresponding to a positive predictive value of 80% (20/25) and a negative predictive value of 98.5% (66/67). TcSC-Ind BM/WBC correctly identified 5 of the 10 infected cases (sensitivity, 50%) and 39 of 41 aseptic cases (specificity, 95.1%) corresponding to a positive and negative predictive values of 41.7% (5/12 cases) and 88.6% (39/44 cases), respectively. Based on these preliminary results, FDG-PET appears to be a promising diagnostic tool for distinguishing septic from aseptic painful hip prostheses.

Key words: FDG-PET, FDG, PET, painful hip prosthesis, arthroplasty, radiolabeled white cell imaging, lose arthroplasty, mechanical loosening, infection