Article

White blood cell scintigraphy for differentiation of infection and aseptic loosening - A retrospective study of 76 painful hip prostheses

Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
Acta Orthopaedica (Impact Factor: 2.77). 11/2007; 78(5):640-7. DOI: 10.1080/17453670710014338
Source: PubMed

ABSTRACT

Diagnosis of an infected arthroplasty is often difficult. Fever, abnormal physical findings, radiographic changes, findings at bone scintigraphy, an elevated erythrocyte sedimentation rate, CRP, and leucocytosis are not specific enough. We evaluated the diagnostic value of white blood cell scintigraphy.
We retrospectively reviewed 76 cases (66 patients) admitted for white blood cell scintigraphy with a clinical suspicion of infection in a hip prosthesis during the period 1995-2003. The leukocytes were labeled with (99m)Tc-HMPAO or with (111)In-oxin. Anterior and posterior views were taken of both hip joints at 3 different time points after injection: 1 h, 3 h, and 22 h. Infection was verified by means of bacteriological cultures, histopathological findings, intraoperative frozen sections, and follow-up (up to 3.5 years).
Of 76 scintigraphies, 51 were negative and 25 were positive. There were 81% true positive, 94% true negative, 6% false positive, and 19% false negative outcomes.
White blood cell scintigraphy with additional late imaging is an effective tool for differentiation between loosening and infection in painful hip arthroplasty.

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    • "Simonsen et al. described a sensitivity of 0.81 and a specificity of 0.94 in detecting septic complications after total hip arthroplasty in leukocyte scintigraphy [15]. The combination of bone scintigraphy with leukocyte scintigraphy is reported to lead to more accurate diagnoses [9] [15]. Positron emission tomography (PET) is considered to be an alternative to bone scintigraphy. "
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    ABSTRACT: To evaluate the usefulness of (99m)Tc-Sulphur colloid when combined with leukocyte scintigraphy in suspected prosthetic hip infection, comparing the results with information from (99m)Tc-HMPAO-leukocyte scintigraphy alone. Seventy patients (42 women, 28 men; mean age 68 +/- 13 years) with painful hip prostheses and suspicion of infection were evaluated prospectively. All patients had bone scintigraphy, (99m)Tc-HMPAO-labelled white blood cell scintigraphy and (99m)Tc-Sulphur colloid bone marrow scintigraphy. ESR and CRP levels were measured in all patients. The final diagnosis was made with microbiological findings or by clinical follow up of at least 12 months. Infections were diagnosed in 12 of the 70 patients (3 coagulase-negative Staphylococcus, 2 Staphylococcus aureus, 2 Staphylococcus epidermidis, 2 enterococcus and 3 polymicrobial agents). ESR and CRP values were higher in patients with infection than in patients without infection (51.8 +/- 29.4 vs. 25.4 +/- 16.4 and 2.8 +/- 2.2 vs. 1.1 +/- 1.3, respectively; p < 0.05). Bone scintigraphy did not show a characteristic pattern to differentiate infection from aseptic loosening. The pool phase of the bone scintigraphy was positive in only 3/12 patients with infection (25 %). Sensitivity and specificity of the leukocyte scintigraphy was 83 % and 57 %, respectively. When the results of the bone marrow scintigraphy were added, these values increased to 92 % and 98 %, respectively. Performing bone marrow scintigraphy significantly improves results when compared with leukocyte scintigraphy alone in the diagnosis of infected hip prostheses. Bone scintigraphy did not help to differentiate aseptic loosening from infection in this series.
    No preview · Article · Nov 2008 · Revista Española de Medicina Nuclear
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    ABSTRACT: Aim To evaluate the usefulness of 99mTc-Sulphur colloid when combined with leukocyte scintigraphy in suspected prosthetic hip infection, comparing the results with information from 99mTc-HMPAO-leukocyte scintigraphy alone. Materials and methods Seventy patients (42 women, 28 men; mean age 68 ± 13 years) with painful hip prostheses and suspicion of infection were evaluated prospectively. All patients had bone scintigraphy, 99mTc-HMPAO-labelled white blood cell scintigraphy and 99mTc-Sulphur colloid bone marrow scintigraphy. ESR and CRP levels were measured in all patients. The final diagnosis was made with microbiological findings or by clinical follow up of at least 12 months. Results Infections were diagnosed in 12 of the 70 patients (3 coagulase-negative Staphylococcus, 2 Staphylococcus aureus, 2 Staphylococcus epidermidis, 2 enterococcus and 3 polymicrobial agents). ESR and CRP values were higher in patients with infection than in patients without infection (51.8 ± 29.4 vs. 25.4 ± 16.4 and 2.8 ± 2.2 vs. 1.1 ± 1.3, respectively; p < 0.05). Bone scintigraphy did not show a characteristic pattern to differentiate infection from aseptic loosening. The pool phase of the bone scintigraphy was positive in only 3/12 patients with infection (25 %). Sensitivity and specificity of the leukocyte scintigraphy was 83 % and 57 %, respectively. When the results of the bone marrow scintigraphy were added, these values increased to 92 % and 98 %, respectively. Conclusion Performing bone marrow scintigraphy significantly improves results when compared with leukocyte scintigraphy alone in the diagnosis of infected hip prostheses. Bone scintigraphy did not help to differentiate aseptic loosening from infection in this series.
    No preview · Article · Dec 2008 · Revista Española de Medicina Nuclear
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