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2017, vol. 74, br. 10, str. 915-920
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Uloga trofazne scintigrafije kostiju sa 99mTc-MDP u dijagnozi periprotetske infekcije kuka i kolena
The role of three-phase 99mTc-MDP bone scintigraphy in the diagnosis of periprosthetic joint infection of the hip and knee
aVojnomedicinska akademija, Institut za nuklearnu medicinu, Beograd bVojnomedicinska akademija, Institut za nuklearnu medicinu, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd cUniverzitet u Beogradu, Medicinski fakultet, Institut za ortopedsko-hirurške bolesti 'Banjica' dUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Klinika za ortopedsku hirurgiju i traumatologiju, Beograd eUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd + Vojnomedicinska akademija, Klinika za endokrinologiju, Beograd
e-adresa: draganpucar@yahoo.com
Sažetak
Uvod/Cilj. U poslednjih pet decenija primarna artroplastika kuka i kolena predstavlja jednu od najčešćih i najefikasnijih hirurških intervencija širom sveta. Infekcija, iako retka, jeste najozbiljnija komplikacija. Nuklearno medicinsko snimanje, koje nije ometeno metalnim hardverom proteskog zgloba, je trenutno modalitet izbora za procenu sumnje na periprotetsku infekciju zgloba. Cilj ovog istraživanja bio je da se proceni dijagnostička tačnost trofazne 99m technetium methylene diphosphonate (99mTc-MDP) scintigrafije kostiju kod periprotetske infekcije kuka i kolena. Metode. Kriterijumi za uključivanje bolesnika u studiju bili su postojanje sumnje na periprotetsku infekciju zgloba kuka i kolena. U ovoj studiji smo ispitivali 45 bolesnika (14 muškaraca i 31 žene) sa 39 implanta kuka i 24 proteze kolena (ukupno 63). Kod svih bolesnika bila je urađena trofazna scintigrafija skeleta nakon intravenske aplikacije 555 MBq 99mTc-MDP. Konačna potvrda infekcije ustanovljena je bio mikrobiološkim ili patohistološkim nalazom. Rezultati. Infekcija je bila potvrđena kod 29 protetskih zglobova, 13 (44,8%) kolena i 16 (55,2%) kuka, a isključena kod 34 protetska zgloba. Povezanost različitih modaliteta negativnih i pozitivnih nalaza 99mTc-MDP trofazne scintigrafije kostiju sa konačnom potvrdom infekcije pokazuje visoku statističku značajnost (p < 0,001). Trofazna scintigrafija skeleta pokazala je visoku osetljivost od 90%, ali skromnu specifičnost od 69,7% u otkrivanju periprotetske infekcije, dok je dijagnostička tačnost bila 79%. Izračunata pozitivna prediktivna vrednost za metodu iznosila je 73%, ali negativna prediktivna vrednost bila je visoka (89%). Naši rezultati trofazne scintigrafije skeleta sa vrednostima osetljivosti od 90%, specifičnosti od 69,7% i dijagnostičke tačnosti od 79% u saglasnosti su sa većinom objavljenih studija, pa i diskretno bolji. Zaključak. Scintigrafija skeleta je osetljiva metoda u dijagnostici periprotetske infekcije, ali je nedovoljno specifična. U otkrivanju periprotetske infekcije, trofazna scintigrafija kostiju može se koristiti kao dijagnostička metoda prve linije samo u cilju njenog isključivanja. Jedino razumno korišćenje scintigrafije kostiju je u kombinaciji sa drugim radionuklidnim metodama visoke specifičnosti.
Abstract
Background/Aim. In the last five decades primary hip and knee arthroplasty is the most common and effective surgical intervention worldwide. Infection, although unfrequented, is the most serious complication. Nuclear medicine imaging, not affected by metallic hardware, is the current imaging modality of choice for the evaluation of suspected joint replacement infection. The aim of this study was to estimate the diagnostic accuracy of three phase 99m technetium methylene diphosphonate (99mTc-MDP) bone scintigraphy in periprosthetic hip and knee joint infection. Methods. Inclusion criteria of patients in the study were suspected knee or hip periprosthetic joint infections. In this study, we examined 45 patients (14 men and 31 women) with 39 hip and 24 knee prosthesis (total 63). In all patients, three-phase bone scintigraphy was performed after intravenous application of 555 MBq of 99mTc-MDP. The final confirmation of infection was microbiological or pathohistology finding. Results. Infection was confirmed in 29 prosthetic joints, in 13 (44.8%) knee and 16 (55.2%) hip joints while there was no infection in 34 prosthetic joints. The connection of different modalities of negative and positive findings 99mTc-MDP three-phase bone scintigraphy with the final confirmation of infection showed a high statistical significance (p < 0.001). Three phase bone scintigraphy showed a high sensitivity of 90% but a modest specificity of 69.7% in the detection of periprosthetic infection with the diagnostic accuracy of 79%. The calculated positive predictive value was 73% but the negative predictive value was high 89%. Our results of three-phase bone scintigraphy with calculated sensitivity, specificity and diagnostic accuracy of 79% are in consent with the majority of published studies, or even slightly better. Conclusion. Bone scintigraphy is sensitive in the diagnosis of periprosthetic infection but insufficiently specific. In the detection of periprosthetic infections three-phase bone scan can be used as a diagnostic method of the first line only aimed at its exclusion. The only reasonable use of bone scintigraphy is in combination with other radionuclide methods with high specificity.
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Reference
|
|
  
|
Aliabadi, P., Tumeh, S.S., Weissman, B.N., McNeil, B.J. (1989) Cemented total hip prosthesis: radiographic and scintigraphic evaluation. Radiology, 173(1): 203-206
|
|
|
Ashbrooke, A.B., Calvert, P.T. (1990) Bone scan appearances after uncemented hip replacement. J R Soc Med, 83(12): 768-9
|
|
4  
|
Bongartz, T., Halligan, C.S., Osmon, D.R., Reinalda, M.S., Bamlet, W.R., Crowson, C.S., Hanssen, A.D., Matteson, E.L. (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis & Rheumatism, 59(12): 1713-1720
|
|
|
Hofmann, A.A., Wyatt, R.W.B., Daniels, A. U., Armstrong, L., Alazraki, N., Taylor, A. (1990) Bone Scans After Total Knee Arthroplasty in Asymptomatic Patients. Clinical Orthopaedics and Related Research, &NA;(251): 183-188
|
|
1
|
Kessler, B., Sendi, P., Graber, P., Knupp, M., Zwicky, L., Hintermann, B., Zimmerli, W. (2012) Risk Factors for Periprosthetic Ankle Joint Infection: A Case-Control Study. Journal of Bone and Joint Surgery-American Volume, 94(20): 1871-1876
|
|
5
|
Kurtz, S., Ong, K., Lau, E., Mowat, F., Halpern, M. (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. Journal of bone and joint surgery. American volume, 89(4): 780-5
|
|
1
|
Lentino, J.R. (2003) Prosthetic Joint Infections: Bane of Orthopedists, Challenge for Infectious Disease Specialists. Clinical Infectious Diseases, 36(9): 1157-1161
|
|
|
Love, C., Tronco, G., Yu, A., Marwin, S., Nichols, K., Palestro, C. (2008) Diagnosing lower extremity (LE) prosthetic joint infection: Bone, gallium & labeled leukocyte imaging. J Nucl Med, 49(Suppl 1): 133P
|
|
1
|
Love, C., Marwin, S.E., Palestro, C.J. (2009) Nuclear Medicine and the Infected Joint Replacement. Seminars in Nuclear Medicine, 39(1): 66-78
|
|
|
Love, C., Din, A.S., Tomas, M.B., Kalapparambath, T.P., Palestro, C.J. (2003) Radionuclide Bone Imaging: An Illustrative Review. RadioGraphics, 23(2): 341-358
|
|
1
|
Osmon, D.R., Berbari, E.F., Berendt, A.R., Lew, D., Zimmerli, W., Steckelberg, J.M., Rao, N., Hanssen, A., Wilson, W.R. (2012) Executive Summary: Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of Americaa. Clinical Infectious Diseases, 56(1): 1-10
|
|
|
Palestro, C.J., Swyer, A.J., Kim, C.K., Goldsmith, S.J. (1991) Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging. Radiology, 179(3): 645-648
|
|
|
Palestro, C., Love, C. (2007) Radionuclide Imaging of Musculoskeletal Infection: Conventional Agents. Seminars in Musculoskeletal Radiology, 11(4): 335-352
|
|
|
Palestro, C.J., Love, C., Miller, T.T. (2006) Imaging of musculoskeletal infections. Best Practice & Research Clinical Rheumatology, 20(6): 1197-1218
|
|
|
Rosenthall, L., Lepanto, L., Raymond, F. (1987) Radiophosphate uptake in asymptomatic knee arthroplasty. J Nucl Med, 28(10): 1546-9
|
|
|
Smith, S.L., Wastie, M.L., Forster, I. (2001) Radionuclide Bone Scintigraphy in the Detection of Significant Complications after Total Knee Joint Replacement. Clinical Radiology, 56(3): 221-224
|
|
|
Tigges, S., Stiles, R.G., Roberson, J.R. (1994) Complications of hip arthroplasty causing periprosthetic radiolucency on plain radiographs. American Journal of Roentgenology, 162(6): 1387-1391
|
|
|
Williams, F., McCall, I.W., Park, W.M., O`Connor, B.T., Morris, V. (1981) Gallium-67 scanning in the painful total hip replacement. Clinical Radiology, 32(4): 431-439
|
|
|
Williamson, B.R. J., McLaughlin, R.E., Wang, G., Miller, C.W., Teates, C. D., Bray, S.T. (1979) Radionuclide Bone Imaging as a Means of Differentiating Loosening and Infection in Patients with a Painful Total Hip Prosthesis. Radiology, 133(3): 723-725
|
|
|
Zajonz, D., Wuthe, L., Tiepolt, S., Brandmeier, P., Prietzel, T., von Salis-Soglio, G.F., Roth, A., Josten, C., Heyde, Christoph-E., Ghanem, M. (2015) Diagnostic work-up strategy for periprosthetic joint infections after total hip and knee arthroplasty: a 12-year experience on 320 consecutive cases. Patient Safety in Surgery, 9(1):
|
|
1
|
Zimmerli, W., Trampuz, A., Ochsner, P.E. (2004) Prosthetic-Joint Infections. New England Journal of Medicine, 351(16): 1645-1654
|
|
|
|
|