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Labeled white blood cell/bone marrow single-photon emission computed tomography with computed tomography fails in

Thomas Falstie-Jensen1, Henrik Daugaard2, Kjeld Søballe1

  • 1Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.

Journal of Shoulder and Elbow Surgery
|February 5, 2019
PubMed
Abstract

Insights

Diagnosing shoulder periprosthetic joint infections (PJI) with labeled leukocyte (WBC) and bone marrow imaging (BM) is challenging. This study found WBC/BM scans have low sensitivity for detecting shoulder PJI and are not recommended for screening failed shoulder arthroplasties.

Area of Science:

  • Orthopedics
  • Nuclear Medicine
  • Infectious Diseases

Background:

  • Shoulder periprosthetic joint infections (PJI) caused by low-virulent bacteria present diagnostic difficulties.
  • Labeled leukocyte (WBC) and technetium 99m sulfur colloid bone marrow imaging (WBC/BM) is the gold standard for lower limb PJI but is laborious and lacks documentation for shoulder arthroplasties.
  • This study aimed to evaluate the diagnostic performance of WBC/BM single-photon emission computed tomography-computed tomography (SPECT-CT) in shoulder PJI.

Purpose of the Study:

  • To investigate the diagnostic performance of WBC/BM SPECT-CT for detecting shoulder PJI.
  • To assess the utility of WBC/BM imaging in patients with failed shoulder arthroplasties.

Main Methods:

  • Patients with failed shoulder arthroplasties underwent a diagnostic program including WBC/BM imaging.
  • Biopsy specimens were obtained during revision surgery and cultured for 14 days.
  • Diagnostic performance metrics (sensitivity, specificity, PPV, NPV) were calculated using biopsy results as the reference standard.

Main Results:

  • Of 49 patients, 11 had confirmed PJI. WBC/BM showed a sensitivity of 0.18 and a specificity of 1.00.
  • The positive predictive value was 1.00, and the negative predictive value was 0.67.
  • No infections caused by Cutibacterium acnes were detected by WBC/BM imaging.

Conclusions:

  • Positive WBC/BM scans were only observed in cases of obvious PJI, adding no value to preoperative diagnosis.
  • WBC/BM SPECT-CT is not recommended as a screening tool for evaluating failed shoulder arthroplasties for infection.
  • The low sensitivity indicates limitations in diagnosing shoulder PJI with this imaging modality.
Keywords:
Revisioncultureshybrid imagingnuclear medicineperiprosthetic infectionrevision shoulder arthroplastyshoulder arthroplasty

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