Role of nuclear medicine in diagnosis of the infected joint replacement

Charito Love, Maria B. Tomas, Scott E. Marwin, Paul V. Pugliese, Christopher J. Palestro

Research output: Contribution to journalArticle

161 Citations (Scopus)

Abstract

Some complications of joint replacement surgery are easily diagnosed; however, differentiating infection from aseptic loosening is difficult because these entities are remarkably similar at clinical and histopathologic examination. Clinical signs and symptoms, laboratory tests, radiography, and joint aspiration are insensitive, nonspecific, or both. Cross-sectional imaging modalities are hampered by artifacts produced by the prosthetic devices themselves. Radionuclide imaging is not affected by the presence of metallic hardware and is therefore useful for evaluating the painful prosthesis. Bone scintigraphy is useful as a screening test, despite an accuracy of only 50%-70%, because normal results essentially exclude a prosthetic complication. The addition of gallium-67, a nonspecific inflammation-imaging agent, improves the accuracy of bone scintigraphy to 70%-80%. The accuracy of combined leukocyte-marrow imaging, 90%, is the highest among available radionuclide studies. Its success is due to the fact that leukocyte imaging is most sensitive for detection of neutrophil-mediated inflammation (ie, infection). The success of leukocyte-marrow imaging is tempered by the limitations of in vitro labeling. In vivo labeling has been investigated, and a murine monoclonal antigranulocyte antibody appears promising. Some investigations have focused on fluorodeoxyglucose imaging. Although this method is sensitive, specificity is a concern.

Original languageEnglish (US)
Pages (from-to)1229-1238
Number of pages10
JournalRadiographics
Volume21
Issue number5
StatePublished - Sep 2001
Externally publishedYes

Fingerprint

Replacement Arthroplasties
Nuclear Medicine
Radionuclide Imaging
Leukocytes
Bone Marrow
Inflammation
Bone and Bones
Gallium
Infection
Radiography
Radioisotopes
Artifacts
Signs and Symptoms
Prostheses and Implants
Neutrophils
Joints
Monoclonal Antibodies
Equipment and Supplies

Keywords

  • Hip, infection, 442.20
  • Hip, prostheses, 442.454
  • Hip, radionuclide studies, 442.1217
  • Knee, infection, 452.20
  • Knee, prostheses, 452.454
  • Knee, radionuclide studies, 452.1217

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Love, C., Tomas, M. B., Marwin, S. E., Pugliese, P. V., & Palestro, C. J. (2001). Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics, 21(5), 1229-1238.

Role of nuclear medicine in diagnosis of the infected joint replacement. / Love, Charito; Tomas, Maria B.; Marwin, Scott E.; Pugliese, Paul V.; Palestro, Christopher J.

In: Radiographics, Vol. 21, No. 5, 09.2001, p. 1229-1238.

Research output: Contribution to journalArticle

Love, C, Tomas, MB, Marwin, SE, Pugliese, PV & Palestro, CJ 2001, 'Role of nuclear medicine in diagnosis of the infected joint replacement', Radiographics, vol. 21, no. 5, pp. 1229-1238.
Love C, Tomas MB, Marwin SE, Pugliese PV, Palestro CJ. Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics. 2001 Sep;21(5):1229-1238.
Love, Charito ; Tomas, Maria B. ; Marwin, Scott E. ; Pugliese, Paul V. ; Palestro, Christopher J. / Role of nuclear medicine in diagnosis of the infected joint replacement. In: Radiographics. 2001 ; Vol. 21, No. 5. pp. 1229-1238.
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