Diagnosis of prosthetic joint infection at the hip using the standard uptake value of three-phase 99mTc-hydroxymethylene diphosphonate SPECT/CT

• Published in: Annals of nuclear medicine Vol. 36; no. 7; pp. 634 - 642
• Main Authors: Yama, Naoya, Nagoya, Satoshi, Sugita, Shintaro, Koyama, Masayuki, Hatakenaka, Masamitsu
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.07.2022; Springer Nature B.V
• Subjects: Bacteria; Computed tomography; Emission analysis; Gram-negative bacteria; Hip; Imaging; Infections; Infiltration; Joint diseases; Joints (anatomy); Leukocytes (neutrophilic); Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Original Article; Photon emission; Prostheses; Radiology; Single photon emission computed tomography; Tomography; Standard uptake value; Prosthetic joint infection; SPECT/CT
• ISSN: 0914-7187; 1864-6433
• DOI: 10.1007/s12149-022-01745-5

Purpose To retrospectively investigate whether the standard uptake value (SUV) of 99mTc-bone single-photon emission computed tomography (SPECT)/CT could be useful for predicting prosthetic joint infection (PJI) at the hip. Patients and methods We analyzed the cases of 37 patients with a suspected PJI at the hip who underwent 99mTc-bone SPECT/CT and surgical intervention with pathological and bacterial examinations. We divided the cases into those with and those without a causative bacterium detected in a surgical specimen, i.e., the positive bacterial culture (PBC) group ( n  = 17) and negative bacterial culture (NBC) group ( n  = 20). Cases with neutrophilic infiltration of surgical specimen comprised the positive neutrophilic infiltration (PINF) group ( n  = 18) and those without INF comprised the non-neutrophilic infiltration (NINF) group ( n  = 19). Quantitative analyses were performed using maximum SUVs and peak SUVs of blood-pool (BP) phase images (SUVmaxBP and SUVpeakBP) and late (LT)-phase images (SUVmaxLT and SUVpeakLT). Results Regarding the bacterial cultures, there were significant differences between the PBC and NBC groups in SUVmaxBP (5.26 ± 1.49 vs. 4.21 ± 1.15, respectively; p  = 0.019), SUVpeakBP (4.89 ± 1.32 vs. 3.87 ± 1.06, p  = 0.012), SUVmaxLT (16.10 ± 6.36 vs. 11.67 ± 4.95, p  = 0.026), and SUVpeakLT (14.58 ± 5.83 vs. 10.49 ± 4.31 p  = 0.036). Regarding neutrophilic infiltration, there were significant differences between the PINF and NINF groups in SUVmaxBP (5.18 ± 1.48 vs. 4.24 ± 1.19, p  = 0.047) and SUVpeakBP (4.78 ± 1.32 vs. 3.92 ± 1.10, p  = 0.043). Conclusion An SUV analysis of 99mTc-bone SPECT/CT is a useful method to differentiate a PJI at the hip from non-infection.