Comparison Between 99mTc-Sulesomab and 18F-FDG PET/CT in a Patient With Suspected Prosthetic Joint Infection

Area of Science:

• Nuclear medicine
• Radiology
• Infectious disease

Background:

• Diagnosing prosthetic joint infection (PJI) presents significant challenges due to the limitations of conventional diagnostic methods.
• Clinical evaluation, laboratory markers, radiography, and joint aspiration often lack sufficient sensitivity and specificity for accurate PJI diagnosis.

Observation:

• A patient presented with fever and bilateral painful hip prostheses, a common but difficult diagnostic scenario.
• Initial imaging with Tc-99m labeled anti-granulocyte antibody (Tc-sulesomab) scan showed only moderate uptake, failing to confirm infection.

Findings:

• Fluorine-18 fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (F-FDG-PET/CT) revealed high tracer uptake in the soft tissues surrounding the right hip prosthesis.
• F-FDG-PET/CT successfully detected a fistula and early bone marrow involvement in the right femur, which were not evident on the initial scan.
• Subsequent fistulography confirmed the presence of the fistula, leading to successful surgical intervention (fistulotomy).

Implications:

• F-18 FDG-PET/CT offers superior diagnostic accuracy for prosthetic joint infections compared to conventional methods.
• This advanced imaging modality can detect subtle signs of infection, including soft tissue involvement, fistulas, and early osseous changes.
• Accurate and early diagnosis using F-18 FDG-PET/CT can guide timely and effective treatment, potentially improving patient outcomes and reducing complications.