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LeukoScan dual-time acquisition protocol and semiquantitative analysis in diagnosis of infection in painful hip prosthesis

¹ Medicina Nucleare, Ospedale S. Maria della Misericordia, Rovigo, Italy; ² Polclinico S. Orsola Malpighi Bologna, Bologna, Italy

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Objectives: To evaluate efficacy of a dual-time acquisition protocol combined with semiquantitative ROI analysis with LeukoScan in the diagnosis of infection in painful hip prosthesis.

Methods: 67 pts were enrolled. All pts had clinical and biochemical suspicious of infection; prosthesis had been implanted 3 mo. to 12 yrs. 24 pts were on antibiotic therapy. Both early 4 hr and delayed 20-24 hr LeukoScan imaging was obtained. For semiquantitative approach, ROI analysis was used in the anterior views to measure the mean radioactivity in the prosthesis by a square ROI method to which BKG measured on the femur was subtracted. A stable or increasing trend in intensity of uptake of at least 20% at the dual-time LeukoScan was considered consistent, while a decreasing pattern was judged a negative result. Final diagnosis was obtained at surgery and/or prolonged clinical and imaging follow-up.

Results: At visual analysis, sensitivity for early and delayed imaging were 94%, specificity was 71% for early imaging and 83% for early and delayed imaging approach. At semiquantitative analysis, sensitivity remains 94%, specificity was 73% for early imaging and 90% for early and delayed imaging approach. 4 false positive early scans were correctly diagnosed as negative at delayed imaging. No differences were observed between pts on or off antibiotic therapy.

Conclusions: Thus, delayed LeukoScan imaging is important in identifying false positive results detect at early imaging. Thus, a dual-time, early and delayed LeukoScan imaging approach is strongly recommended to increase the diagnostic accuracy. The semiquantitative analysis approach we adopted proved to further increase the specificity of the method.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Banti, E. Articles by Rubello, D. PubMed Articles by Banti, E. Articles by Rubello, D.