Related Experiment Video
Updated: Jun 7, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Detection of Synchronous Foci of Infection Using Positron Emission Tomography in Septic Patients Who Have a
Jan Reinhard1, Stefanie Heidemanns2, Markus Rupp3
1Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany; Department of Orthopaedic Surgery, University Medical Center Regensburg, Bad Abbach, Germany.
Background:
Periprosthetic joint infection (PJI) with sepsis is a life-threatening condition and identification of synchronous foci of infection is challenging. Positron emission tomography using 18F-fluorodeoxyglucose combined with computed tomography (18F-FDG-PET/CT) is useful to detect PJI in elective, nonseptic patients. We hypothesized that in patients who have PJI and concomitant sepsis requiring intensive care, 18F-FDG-PET/CT could accurately identify synchronous foci of infection. We addressed the following questions: (1) How often were synchronous foci of infection detected?; (2) What were the confirmation rates of these infection foci by other complementary state-of-the-art methods?; (3) Did 18F-FDG-PET/CT findings result in surgical treatment?; and (4) What is the risk of synchronous PJI in patients who have PJI and concomitant sepsis who have another indwelling arthroplasty?
Methods:
We retrospectively analyzed mechanically ventilated septic PJI patients who underwent 18F-FDG-PET/CT between January 1, 2017 and December 21, 2022. The identified synchronous foci of infection were categorized into musculoskeletal, cardiovascular, pulmonary, or other infections and compared to results from tissue culture, histopathology, magnetic resonance imaging, or transesophageal echocardiography.
Results:
We identified 17 eligible patients. The 18F-FDG-PET/CT revealed at least one additional infection focus in 15 patients with the following distribution: musculoskeletal (n = 12), cardiovascular (n = 3), pulmonary (n = 13), and other infections (n = 6). Synchronous foci of infection identified with 18F-FDG-PET/CT were confirmed by another state-of-the-art method in 1 all 15 patients. Diagnoses with 18F-FDG-PET/CT led to additional surgery in 11 patients. Of the patients, 10 of 17 had another arthroplasty with a risk in three of synchronous PJI.
Conclusions:
We highlight the value of 18F-FDG-PET/CT in patients who have PJI and sepsis, emphasizing its role in the comprehensive evaluation of these patients for subsequent therapeutic decision-making.
Insights
Positron emission tomography using 18F-fluorodeoxyglucose combined with computed tomography (18F-FDG-PET/CT) effectively identifies synchronous infection foci in patients with periprosthetic joint infection (PJI) and sepsis. This imaging modality aids in diagnosis, guides surgical treatment, and assesses infection risk in patients with multiple implants.
Area of Science:
- Nuclear medicine imaging
- Infectious disease diagnostics
- Sepsis management
Background:
- Periprosthetic joint infection (PJI) with sepsis is a critical condition requiring accurate identification of all infection sources.
- Diagnosing synchronous infection foci in septic PJI patients is challenging.
- 18F-FDG-PET/CT is established for detecting PJI in non-septic patients.
Purpose of the Study:
- To evaluate the accuracy of 18F-FDG-PET/CT in identifying synchronous infection foci in mechanically ventilated septic PJI patients.
- To determine the confirmation rates of detected foci by other methods.
- To assess the impact of 18F-FDG-PET/CT findings on surgical treatment and risk of synchronous PJI in patients with multiple implants.
Main Methods:
- Retrospective analysis of 17 mechanically ventilated septic PJI patients who underwent 18F-FDG-PET/CT between 2017 and 2022.
- Categorization of identified synchronous foci (musculoskeletal, cardiovascular, pulmonary, other).
- Comparison of 18F-FDG-PET/CT findings with results from tissue culture, histopathology, MRI, or TEE.
Main Results:
- 18F-FDG-PET/CT detected at least one additional infection focus in 15 out of 17 patients.
- The most common foci were musculoskeletal (n=12), pulmonary (n=13), cardiovascular (n=3), and other (n=6).
- All detected foci were confirmed by other methods; findings led to additional surgery in 11 patients, and 3 of 10 patients with multiple implants had synchronous PJI.
Conclusions:
- 18F-FDG-PET/CT is valuable for comprehensive evaluation of septic PJI patients.
- The imaging modality aids in identifying synchronous infection foci, influencing therapeutic decisions.
- It plays a crucial role in managing complex cases of PJI with sepsis.
More Related Videos
07:48High Spatial Resolution Chemical Imaging of Implant-Associated Infections with X-ray Excited Luminescence Chemical Imaging Through Tissue
Published on: September 30, 2022
18:40Combined In vivo Optical and µCT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice
Published on: October 16, 2014
Related Concept Videos
01:29Positron Emission Tomography
One of the main requirements of a PET scan is a positron-emitting radioisotope, which is produced in a cyclotron and then attached to a substance used by the part of the body...
01:25Imaging Studies II: Positron Emission Tomography and Scintigraphy
Fundamental Principles of PET
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...