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Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS

M Kiran1, T D Donnelly2, C Armstrong1

  • 1Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

The Bone & Joint Journal
|August 1, 2019
PubMed
Abstract

Insights

F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scans can help rule out prosthetic joint infection (PJI) in total hip arthroplasty (THA) patients. However, a positive FDG PET scan may not definitively confirm PJI due to a high false-positive rate.

Area of Science:

  • Orthopedics
  • Nuclear Medicine
  • Infectious Diseases

Background:

  • Prosthetic joint infection (PJI) and aseptic loosening are common complications of total hip arthroplasty (THA), often presenting with pain and osteolysis.
  • The Musculoskeletal Infection Society (MSIS) has established criteria for diagnosing PJI.

Purpose of the Study:

  • To evaluate the diagnostic utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scans in the preoperative diagnosis of septic loosening in THA.
  • To assess FDG PET/CT performance against the current MSIS criteria for PJI.

Main Methods:

  • A prospective study included 130 patients with painful, cemented THAs.
  • Preoperative assessments included inflammatory markers, joint aspiration, and FDG PET/CT scans.
  • Diagnostic utility was analyzed based on MSIS criteria and culture results.

Main Results:

  • FDG PET/CT demonstrated high sensitivity (94.87%) and negative predictive value (94.59%) when compared to MSIS criteria.
  • However, the specificity was low (38.46%), resulting in a high false-positive rate (60.21%).
  • The false-positive rate of FDG PET/CT compared to culture alone was 77.4%.

Conclusions:

  • FDG PET/CT plays a role in the preoperative evaluation of suspected PJI, particularly in ruling out infection.
  • The study highlights a significant false-positive rate, indicating that a positive FDG PET/CT scan may not be sufficient for a definitive PJI diagnosis.
  • Further evaluation alongside clinical and microbiological data is recommended when interpreting positive FDG PET/CT findings.
Keywords:
FDGPositron Emission TomographyProsthetic joint infection

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