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J Nucl Med. 2008; 49 (Supplement 1):270P
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General Clinical Specialties: Musculoskeletal

Musculoskeletal Posters

The role of FDG-PET in interim spacers after revision surgery for hip prosthesis infection

Shih-Hsin Chen1, Kung-Chu Ho1, Pang-Shin Hsieh2, Mel Shiuann-Sheng Lee2 and Tzu-Chen Yen1

1 Dept of Nuclear Medicine; 2 Dept of Orthopedics, Chang Gung Memorial Hospital & University, Taoyuan, Taiwan

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Objectives: The aim was to investigate the role of PET in ruling out interim spacer infection in patients received revision surgery for primary prosthesis infection.

Methods: 12 patients with hip interim spacers after prior revision surgery (GrA) were investigated, with 12 patients with painful primary hip prostheses (GrB) as control. 22 patients (12 GrA, 10 GrB) had serologic profiles including the C-reactive protein (CRP) and all had PET/CT before operation. The images were analyzed with both attenuation correction (AC) and non-attenuation correction (NAC). The interpretation was made by three experienced nuclear physicians with at least two consensuses. The CRP was defined as positive if ≥10 mg/L. The final results were based on culture results, intra-operative findings, surgeon’s judgment, and clinical follow-up.

Results: In GrA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 100%, 50%, 50%, 100%, and 67% in PET with AC and were 100%, 63%, 57%, 100%, and 75% with NAC. In the GrB, the sensitivity, specificity, PPV, NPV, and accuracy were 100%, 63%, 57%, 100%, and 75% in PET with AC and were 100%, 88%, 80%, 100%, and 92% with NAC. CRP defined 17 positive (8 true positive, 9 false positive) and 5 negative (all true negative) results. Of the 9 CRP false positive patients, PET was true negative in 7 (3 in GrA and 4 in GrB). Of the 5 CRP negative patients, PET was false positive in 2 (in GrA).

Conclusions: PET had higher accuracy in GrB than in GrA. However, in GrA, PET could rule out more infections than CRP in non-infected patients (63% vs. 50%) and could exclude 88% of infections when combined with CRP. NAC is recommended for PET scans for hip prostheses infections.





This Article
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Right arrow Alert me to new issues of the journal
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Right arrow Articles by Chen, S.-H.
Right arrow Articles by Yen, T.-C.
PubMed
Right arrow Articles by Chen, S.-H.
Right arrow Articles by Yen, T.-C.