open access

Vol 20, No 2 (2017)
Original articles
Published online: 2017-05-25
Submitted: 2016-12-25
Accepted: 2017-04-04
Get Citation

A retrospective analysis of the accuracy of radioactively labeled autologous leukocytes in patients with infected prosthetic joints

Lindsay Brammen, Christopher J Palestro, Johannes Holinka, Reinhard Windhager, Helmut Sinzinger
DOI: 10.5603/NMR.2017.0013
·
Pubmed: 28555449
·
Nucl. Med. Rev 2017;20(2):81-87.

open access

Vol 20, No 2 (2017)
Original articles
Published online: 2017-05-25
Submitted: 2016-12-25
Accepted: 2017-04-04

Abstract

BACKGROUND: Labeled leukocyte scintigraphy (LS) is considered a valuable tool in preoperative diagnosis of prosthetic joint infections (PJI). The aim of this study was to determine the accuracy of LS combined with bone marrow scintigraphy (BMS), as well as inflammation markers CRP and WBC, in detecting infection in patients with prosthetic joints.

MATERIAL AND METHODS: This study included patients suspected of having PJI between January and September 2013 at the Vienna General Hospital who underwent imaging with 99mTc-HMPAO labeled autologous leukocytes and subsequent BMS. Diagnostic accuracy was assessed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive

value (NPV).

RESULTS: A total of 48 patients were included. The most common joint investigated was knee (25), followed by hip (9), shoulder (2), and elbow (1). Other parts of the body investigated included the femur (6), tibia (2), leg (2), and foot (1). The pathogens most frequently isolated included Staphylococcus epidermidis and Candida albicans. The sensitivity of LS was 60%, specificity 97%, PPV 86% and NPV 90%. Overall accuracy was calculated to be 90%.

CONCLUSIONS: This study was able to demonstrate that 99mTc-HMPAO labeled autologous leukocytes in patients presenting with symptoms of PJI is accurate. In contrast, however, inflammation markers CRP and WBC are not accurate pre-diagnostic markers for PJI.

Abstract

BACKGROUND: Labeled leukocyte scintigraphy (LS) is considered a valuable tool in preoperative diagnosis of prosthetic joint infections (PJI). The aim of this study was to determine the accuracy of LS combined with bone marrow scintigraphy (BMS), as well as inflammation markers CRP and WBC, in detecting infection in patients with prosthetic joints.

MATERIAL AND METHODS: This study included patients suspected of having PJI between January and September 2013 at the Vienna General Hospital who underwent imaging with 99mTc-HMPAO labeled autologous leukocytes and subsequent BMS. Diagnostic accuracy was assessed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive

value (NPV).

RESULTS: A total of 48 patients were included. The most common joint investigated was knee (25), followed by hip (9), shoulder (2), and elbow (1). Other parts of the body investigated included the femur (6), tibia (2), leg (2), and foot (1). The pathogens most frequently isolated included Staphylococcus epidermidis and Candida albicans. The sensitivity of LS was 60%, specificity 97%, PPV 86% and NPV 90%. Overall accuracy was calculated to be 90%.

CONCLUSIONS: This study was able to demonstrate that 99mTc-HMPAO labeled autologous leukocytes in patients presenting with symptoms of PJI is accurate. In contrast, however, inflammation markers CRP and WBC are not accurate pre-diagnostic markers for PJI.

Get Citation

Keywords

leukocyte labeling, prosthetic joint, infection, 99mTc-HMPAO, scintigraphy

About this article
Title

A retrospective analysis of the accuracy of radioactively labeled autologous leukocytes in patients with infected prosthetic joints

Journal

Nuclear Medicine Review

Issue

Vol 20, No 2 (2017)

Pages

81-87

Published online

2017-05-25

DOI

10.5603/NMR.2017.0013

Pubmed

28555449

Bibliographic record

Nucl. Med. Rev 2017;20(2):81-87.

Keywords

leukocyte labeling
prosthetic joint
infection
99mTc-HMPAO
scintigraphy

Authors

Lindsay Brammen
Christopher J Palestro
Johannes Holinka
Reinhard Windhager
Helmut Sinzinger

References (54)
  1. Gemmel F, Van den Wyngaert H, Love C, et al. Prosthetic joint infections: radionuclide state-of-the-art imaging. Eur J Nucl Med Mol Imaging. 2012; 39(5): 892–909.
  2. Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med. 2009; 39(1): 66–78.
  3. Lazzeri E, Manca M, Molea N, et al. Clinical validation of the avidin/indium-111 biotin approach for imaging infection/inflammation in orthopaedic patients. Eur J Nucl Med. 1999; 26(6): 606–614.
  4. Love C, Tomas MB, Marwin SE, et al. Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics. 2001; 21(5): 1229–1238.
  5. Trampuz A, Zimmerli W, Zimmerli W, et al. Prosthetic-joint infections. N Engl J Med. 2004; 351(16): 1645–1654.
  6. Zimmerli W. Infection and musculoskeletal conditions: Prosthetic-joint-associated infections. Best Pract Res Clin Rheumatol. 2006; 20(6): 1045–1063.
  7. Cataldo MA, Petrosillo N, Cipriani M, et al. Prosthetic joint infection: recent developments in diagnosis and management. J Infect. 2010; 61(6): 443–448.
  8. Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013; 95-B(11): 1450–1452.
  9. Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010; 92(11): 2102–2109.
  10. Diaz-Ledezma C, Lamberton C, Lichstein P, et al. Diagnosis of Periprosthetic Joint Infection: The Role of Nuclear Medicine May Be Overestimated. J Arthroplasty. 2015; 30(6): 1044–1049.
  11. Datz FL. Indium-111-labeled leukocytes for the detection of infection: current status. Semin Nucl Med. 1994; 24(2): 92–109.
  12. McAfee JG, Thakur ML. Survey of radioactive agents for in vitro labeling of phagocytic leukocytes. II. Particles. J Nucl Med. 1976; 17(6): 488–492.
  13. Mader JT, Brown GL, Guckian JC, et al. A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis. 1980; 142(6): 915–922.
  14. King AD, Peters AM, Stuttle AW, et al. Imaging of bone infection with labelled white blood cells: role of contemporaneous bone marrow imaging. Eur J Nucl Med. 1990; 17(3-4): 148–151.
  15. Palestro CJ, Kim CK, Swyer AJ, et al. Total-hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. J Nucl Med. 1990; 31(12): 1950–1955.
  16. Palestro CJ, Swyer AJ, Kim CK, et al. Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging. Radiology. 1991; 179(3): 645–648.
  17. Seabold JE, Nepola JV, Marsh JL, et al. Postoperative bone marrow alterations: potential pitfalls in the diagnosis of osteomyelitis with In-111-labeled leukocyte scintigraphy. Radiology. 1991; 180(3): 741–747.
  18. Palestro CJ, Roumanas P, Swyer AJ, et al. Diagnosis of musculoskeletal infection using combined In-111 labeled leukocyte and Tc-99m SC marrow imaging. Clin Nucl Med. 1992; 17(4): 269–273.
  19. Achong DM, Oates E. The computer-generated bone marrow subtraction image: a valuable adjunct to combined In-111 WBC/Tc-99m in sulfur colloid scintigraphy for musculoskeletal infection. Clin Nucl Med. 1994; 19(3): 188–193.
  20. Palestro CJ, Mehta HH, Patel M, et al. Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium-99m sulfur colloid scintigraphy. J Nucl Med. 1998; 39(2): 346–350.
  21. Joseph TN, Mujtaba M, Chen AL, et al. Efficacy of combined technetium-99m sulfur colloid/indium-111 leukocyte scans to detect infected total hip and knee arthroplasties. J Arthroplasty. 2001; 16(6): 753–758.
  22. Palestro CJ. Nuclear medicine, the painful prosthetic joint, and orthopedic infection. J Nucl Med. 2003; 44(6): 927–929.
  23. El Espera I, Blondet C, Moullart V, et al. The usefulness of 99mTc sulfur colloid bone marrow scintigraphy combined with 111In leucocyte scintigraphy in prosthetic joint infection. Nucl Med Commun. 2004; 25(2): 171–175.
  24. Love C, Marwin SE, Tomas MB, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging. J Nucl Med. 2004; 45(11): 1864–1871.
  25. Fuster D, Duch J, Soriano A, et al. [Potential use of bone marrow scintigraphy in suspected prosthetic hip infection evaluated with 99mTc-HMPAO-leukocytes]. Rev Esp Med Nucl. 2008; 27(6): 430–435.
  26. Palestro CJ, Love C, Tronco GG, et al. Combined labeled leukocyte and technetium 99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection. Radiographics. 2006; 26(3): 859–870.
  27. Devillers A, Moisan A, Jean S, et al. Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy for the diagnosis of bone and joint infections: a retrospective study in 116 patients. Eur J Nucl Med. 1995; 22(4): 302–307.
  28. Mulamba L, Ferrant A, Leners N, et al. Indium-111 leucocyte scanning in the evaluation of painful hip arthroplasty. Acta Orthop Scand. 1983; 54(5): 695–697.
  29. Pill SG, Parvizi J, Tang PH, et al. Comparison of fluorodeoxyglucose positron emission tomography and (111)indium-white blood cell imaging in the diagnosis of periprosthetic infection of the hip. J Arthroplasty. 2006; 21(6 Suppl 2): 91–97.
  30. Sinzinger H, Granegger S. The effect of various antibiotics on the labelling efficiency of human white blood cells with 111In-oxine. Nucl Med Commun. 1988; 9(8): 597–601.
  31. Al-Sheikh W, Sfakianakis GN, Mnaymneh W, et al. Subacute and chronic bone infections: diagnosis using In-111, Ga-67 and Tc-99m MDP bone scintigraphy, and radiography. Radiology. 1985; 155(2): 501–506.
  32. Johnson JA, Christie MJ, Sandler MP, et al. Detection of occult infection following total joint arthroplasty using sequential technetium-99m HDP bone scintigraphy and indium-111 WBC imaging. J Nucl Med. 1988; 29(8): 1347–1353.
  33. McKillop JH, McKay I, Cuthbert GF, et al. Scintigraphic evaluation of the painful prosthetic joint: a comparison of gallium-67 citrate and indium-111 labelled leucocyte imaging. Clin Radiol. 1984; 35(3): 239–241.
  34. Glaudemans AW, Galli F, Pacilio M, et al. Leukocyte and bacteria imaging in prosthetic joint infection. Eur Cell Mater. 2013; 25: 61–77.
  35. Datz FL, Thorne DA. Effect of chronicity of infection on the sensitivity of the In-111-labeled leukocyte scan. AJR Am J Roentgenol. 1986; 147(4): 809–812.
  36. Palestro CJ. Nuclear medicine and the failed joint replacement: Past, present, and future. World J Radiol. 2014; 6(7): 446–458.
  37. Palestro CJ, Love C, Bhargava KK. Labeled leukocyte imaging: current status and future directions. Q J Nucl Med Mol Imaging. 2009; 53(1): 105–123.
  38. Yuan K, Chen HL, Cui ZM. Diagnostic accuracy of C-reactive protein for periprosthetic joint infection: a meta-analysis. Surg Infect (Larchmt). 2014; 15(5): 548–559.
  39. Glithero PR, Grigoris P, Harding LK, et al. White cell scans and infected joint replacements. Failure to detect chronic infection. J Bone Joint Surg Br. 1993; 75(3): 371–374.
  40. Claassen L, Radtke K, Ettinger M, et al. Preoperative diagnostic for periprosthetic joint infection prior to total knee revision arthroplasty. Orthop Rev (Pavia). 2014; 6(3): 5437.
  41. Tam HH, Bhaludin B, Rahman F, et al. SPECT-CT in total hip arthroplasty. Clin Radiol. 2014; 69(1): 82–95.
  42. Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. J Nucl Med. 2006; 47(12): 1908–1913.
  43. Kim HOk, Na SJ, Oh SJ, et al. Usefulness of adding SPECT/CT to 99mTc-hexamethylpropylene amine oxime (HMPAO)-labeled leukocyte imaging for diagnosing prosthetic joint infections. J Comput Assist Tomogr. 2014; 38(2): 313–319.
  44. Graute V, Feist M, Lehner S, et al. Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results. Eur J Nucl Med Mol Imaging. 2010; 37(9): 1751–1759.
  45. Gravius S, Gebhard M, Ackermann D, et al. [Analysis of 18F-FDG uptake pattern in PET for diagnosis of aseptic loosening versus prosthesis infection after total knee arthroplasty. A prospective pilot study]. Nuklearmedizin. 2010; 49(3): 115–123.
  46. Basu S, Kwee TC, Saboury B, et al. FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses. Clin Nucl Med. 2014; 39(7): 609–615.
  47. Zhuang H, Duarte PS, Pourdehnad M, et al. The promising role of 18F-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med. 2001; 42(1): 44–48.
  48. Cremerius U, Mumme T, Reinartz P, et al. [Analysis of (18)F-FDG uptake patterns in PET for diagnosis of septic and aseptic loosening after total hip arthroplasty]. Nuklearmedizin. 2003; 42(6): 234–239.
  49. Reinartz P, Mumme T, Hermanns B, et al. Radionuclide imaging of the painful hip arthroplasty: positron-emission tomography versus triple-phase bone scanning. J Bone Joint Surg Br. 2005; 87(4): 465–470.
  50. Stumpe KDM, Nötzli HP, Zanetti M, et al. FDG PET for differentiation of infection and aseptic loosening in total hip replacements: comparison with conventional radiography and three-phase bone scintigraphy. Radiology. 2004; 231(2): 333–341.
  51. García-Barrecheguren E, Rodríguez Fraile M, Toledo Santana G, et al. [FDG-PET: a new diagnostic approach in hip prosthetic replacement]. Rev Esp Med Nucl. 2007; 26(4): 208–220.
  52. Stumpe KDM, Romero J, Ziegler O, et al. The value of FDG-PET in patients with painful total knee arthroplasty. Eur J Nucl Med Mol Imaging. 2006; 33(10): 1218–1225.
  53. Delank KS, Schmidt M, Michael JWP, et al. The implications of 18F-FDG PET for the diagnosis of endoprosthetic loosening and infection in hip and knee arthroplasty: results from a prospective, blinded study. BMC Musculoskelet Disord. 2006; 7: 20.
  54. Jin H, Yuan L, Li C, et al. Diagnostic performance of FDG PET or PET/CT in prosthetic infection after arthroplasty: a meta-analysis. Q J Nucl Med Mol Imaging. 2014; 58(1): 85–93.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., Świętokrzyska 73 street, 80–180 Gdańsk, Poland

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl