Diagnosing infection in the failed joint replacement: A comparison of coincidence detection 18F-FDG and 111in-labeled leukocyte/99mTc-sulfur colloid marrow imaging

Charito Love, Scott E. Marwin, Maria B. Tomas, Eugene S. Krauss, Gene G. Tronco, Kuldeep K. Bhargava, Kenneth J. Nichols, Christopher J. Palestro

Research output: Contribution to journalArticle

171 Citations (Scopus)

Abstract

The objectives of this study were to investigate 18F-FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements. Methods: Fifty-nine patients - with painful, failed, lower extremity joint prostheses, 40 hip and 19 knee - who underwent 18F-FDG, labeled leukocyte, and bone marrow imaging, and had histopathologic and microbiologic confirmation of the final diagnosis, formed the basis of this investigation. 18F-FDG images were interpreted as positive for infection using 4 different criteria: criterion 1: any periprosthetic activity, regardless of location or intensity; criterion 2: periprosthetic activity on the 18F-FDG image, without corresponding activity on the marrow image; criterion 3: only bone-prosthesis interface activity, regardless of intensity; criterion 4: semiquantitative analysis - a lesion-to-background ratio was generated, and the cutoff value yielding the highest accuracy for determining the presence of infection was determined. Labeled leukocyte/marrow images were interpreted as positive for infection when periprosthetic activity was present on the labeled leukocyte image without corresponding activity on the marrow image. Results: Twenty-five (42%) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of 18F-FDG, by criterion, were as follows: criterion 1: 100%, 9%, 47%; criterion 2: 96%, 35%, 61%; criterion 3: 52%, 44%, 47%; criterion 4: 36%, 97%, 71%. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100%, 91%, and 95%, respectively. WBC/marrow imaging, which was more accurate than any of the 18F-FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P < 0.001) and criterion 4 (P < 0.001) and was significantly more specific than criterion 1 (P < 0.001), criterion 2 (P < 0.001), and criterion 3 (P < 0.001). Conclusion: Regardless of how the images are interpreted, coincidence detection-based 18F-FDG imaging is less accurate than, and cannot replace, labeled leukocyte/marrow imaging for diagnosing infection of the failed prosthetic joint.

Original languageEnglish (US)
Pages (from-to)1864-1871
Number of pages8
JournalJournal of Nuclear Medicine
Volume45
Issue number11
StatePublished - Nov 1 2004
Externally publishedYes

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Replacement Arthroplasties
Fluorodeoxyglucose F18
Colloids
Sulfur
Leukocytes
Bone Marrow
Infection
Knee
Hip
Lower Extremity
Joints
Joint Prosthesis
Sensitivity and Specificity
Hip Prosthesis
Prostheses and Implants

Keywords

  • In-labeled leukocytes
  • F-FDG
  • Coincidence detection
  • Prosthetic joint infection

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Diagnosing infection in the failed joint replacement : A comparison of coincidence detection 18F-FDG and 111in-labeled leukocyte/99mTc-sulfur colloid marrow imaging. / Love, Charito; Marwin, Scott E.; Tomas, Maria B.; Krauss, Eugene S.; Tronco, Gene G.; Bhargava, Kuldeep K.; Nichols, Kenneth J.; Palestro, Christopher J.

In: Journal of Nuclear Medicine, Vol. 45, No. 11, 01.11.2004, p. 1864-1871.

Research output: Contribution to journalArticle

Love, C, Marwin, SE, Tomas, MB, Krauss, ES, Tronco, GG, Bhargava, KK, Nichols, KJ & Palestro, CJ 2004, 'Diagnosing infection in the failed joint replacement: A comparison of coincidence detection 18F-FDG and 111in-labeled leukocyte/99mTc-sulfur colloid marrow imaging', Journal of Nuclear Medicine, vol. 45, no. 11, pp. 1864-1871.
Love, Charito ; Marwin, Scott E. ; Tomas, Maria B. ; Krauss, Eugene S. ; Tronco, Gene G. ; Bhargava, Kuldeep K. ; Nichols, Kenneth J. ; Palestro, Christopher J. / Diagnosing infection in the failed joint replacement : A comparison of coincidence detection 18F-FDG and 111in-labeled leukocyte/99mTc-sulfur colloid marrow imaging. In: Journal of Nuclear Medicine. 2004 ; Vol. 45, No. 11. pp. 1864-1871.
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title = "Diagnosing infection in the failed joint replacement: A comparison of coincidence detection 18F-FDG and 111in-labeled leukocyte/99mTc-sulfur colloid marrow imaging",
abstract = "The objectives of this study were to investigate 18F-FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements. Methods: Fifty-nine patients - with painful, failed, lower extremity joint prostheses, 40 hip and 19 knee - who underwent 18F-FDG, labeled leukocyte, and bone marrow imaging, and had histopathologic and microbiologic confirmation of the final diagnosis, formed the basis of this investigation. 18F-FDG images were interpreted as positive for infection using 4 different criteria: criterion 1: any periprosthetic activity, regardless of location or intensity; criterion 2: periprosthetic activity on the 18F-FDG image, without corresponding activity on the marrow image; criterion 3: only bone-prosthesis interface activity, regardless of intensity; criterion 4: semiquantitative analysis - a lesion-to-background ratio was generated, and the cutoff value yielding the highest accuracy for determining the presence of infection was determined. Labeled leukocyte/marrow images were interpreted as positive for infection when periprosthetic activity was present on the labeled leukocyte image without corresponding activity on the marrow image. Results: Twenty-five (42{\%}) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of 18F-FDG, by criterion, were as follows: criterion 1: 100{\%}, 9{\%}, 47{\%}; criterion 2: 96{\%}, 35{\%}, 61{\%}; criterion 3: 52{\%}, 44{\%}, 47{\%}; criterion 4: 36{\%}, 97{\%}, 71{\%}. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100{\%}, 91{\%}, and 95{\%}, respectively. WBC/marrow imaging, which was more accurate than any of the 18F-FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P < 0.001) and criterion 4 (P < 0.001) and was significantly more specific than criterion 1 (P < 0.001), criterion 2 (P < 0.001), and criterion 3 (P < 0.001). Conclusion: Regardless of how the images are interpreted, coincidence detection-based 18F-FDG imaging is less accurate than, and cannot replace, labeled leukocyte/marrow imaging for diagnosing infection of the failed prosthetic joint.",
keywords = "In-labeled leukocytes, F-FDG, Coincidence detection, Prosthetic joint infection",
author = "Charito Love and Marwin, {Scott E.} and Tomas, {Maria B.} and Krauss, {Eugene S.} and Tronco, {Gene G.} and Bhargava, {Kuldeep K.} and Nichols, {Kenneth J.} and Palestro, {Christopher J.}",
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T2 - A comparison of coincidence detection 18F-FDG and 111in-labeled leukocyte/99mTc-sulfur colloid marrow imaging

AU - Love, Charito

AU - Marwin, Scott E.

AU - Tomas, Maria B.

AU - Krauss, Eugene S.

AU - Tronco, Gene G.

AU - Bhargava, Kuldeep K.

AU - Nichols, Kenneth J.

AU - Palestro, Christopher J.

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N2 - The objectives of this study were to investigate 18F-FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements. Methods: Fifty-nine patients - with painful, failed, lower extremity joint prostheses, 40 hip and 19 knee - who underwent 18F-FDG, labeled leukocyte, and bone marrow imaging, and had histopathologic and microbiologic confirmation of the final diagnosis, formed the basis of this investigation. 18F-FDG images were interpreted as positive for infection using 4 different criteria: criterion 1: any periprosthetic activity, regardless of location or intensity; criterion 2: periprosthetic activity on the 18F-FDG image, without corresponding activity on the marrow image; criterion 3: only bone-prosthesis interface activity, regardless of intensity; criterion 4: semiquantitative analysis - a lesion-to-background ratio was generated, and the cutoff value yielding the highest accuracy for determining the presence of infection was determined. Labeled leukocyte/marrow images were interpreted as positive for infection when periprosthetic activity was present on the labeled leukocyte image without corresponding activity on the marrow image. Results: Twenty-five (42%) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of 18F-FDG, by criterion, were as follows: criterion 1: 100%, 9%, 47%; criterion 2: 96%, 35%, 61%; criterion 3: 52%, 44%, 47%; criterion 4: 36%, 97%, 71%. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100%, 91%, and 95%, respectively. WBC/marrow imaging, which was more accurate than any of the 18F-FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P < 0.001) and criterion 4 (P < 0.001) and was significantly more specific than criterion 1 (P < 0.001), criterion 2 (P < 0.001), and criterion 3 (P < 0.001). Conclusion: Regardless of how the images are interpreted, coincidence detection-based 18F-FDG imaging is less accurate than, and cannot replace, labeled leukocyte/marrow imaging for diagnosing infection of the failed prosthetic joint.

AB - The objectives of this study were to investigate 18F-FDG imaging, using a coincidence detection system, for diagnosing prosthetic joint infection and to compare it with combined 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging in patients with failed lower extremity joint replacements. Methods: Fifty-nine patients - with painful, failed, lower extremity joint prostheses, 40 hip and 19 knee - who underwent 18F-FDG, labeled leukocyte, and bone marrow imaging, and had histopathologic and microbiologic confirmation of the final diagnosis, formed the basis of this investigation. 18F-FDG images were interpreted as positive for infection using 4 different criteria: criterion 1: any periprosthetic activity, regardless of location or intensity; criterion 2: periprosthetic activity on the 18F-FDG image, without corresponding activity on the marrow image; criterion 3: only bone-prosthesis interface activity, regardless of intensity; criterion 4: semiquantitative analysis - a lesion-to-background ratio was generated, and the cutoff value yielding the highest accuracy for determining the presence of infection was determined. Labeled leukocyte/marrow images were interpreted as positive for infection when periprosthetic activity was present on the labeled leukocyte image without corresponding activity on the marrow image. Results: Twenty-five (42%) prostheses, 14 hip and 11 knee, were infected. The sensitivity, specificity, and accuracy of 18F-FDG, by criterion, were as follows: criterion 1: 100%, 9%, 47%; criterion 2: 96%, 35%, 61%; criterion 3: 52%, 44%, 47%; criterion 4: 36%, 97%, 71%. The sensitivity, specificity, and accuracy of labeled leukocyte/marrow imaging were 100%, 91%, and 95%, respectively. WBC/marrow imaging, which was more accurate than any of the 18F-FDG criteria for all prostheses, as well as for hips and knees separately, was significantly more sensitive than criterion 3 (P < 0.001) and criterion 4 (P < 0.001) and was significantly more specific than criterion 1 (P < 0.001), criterion 2 (P < 0.001), and criterion 3 (P < 0.001). Conclusion: Regardless of how the images are interpreted, coincidence detection-based 18F-FDG imaging is less accurate than, and cannot replace, labeled leukocyte/marrow imaging for diagnosing infection of the failed prosthetic joint.

KW - In-labeled leukocytes

KW - F-FDG

KW - Coincidence detection

KW - Prosthetic joint infection

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