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Vol 20, No 2 (2017)
Research paper
Submitted: 2016-12-25
Accepted: 2017-04-04
Published online: 2017-05-25
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A retrospective analysis of the accuracy of radioactively labeled autologous leukocytes in patients with infected prosthetic joints

Lindsay Brammen1, Christopher J Palestro2, Johannes Holinka3, Reinhard Windhager4, Helmut Sinzinger45
DOI: 10.5603/NMR.2017.0013
·
Pubmed: 28555449
·
Nucl. Med. Rev 2017;20(2):81-87.
Affiliations
  1. Department of Surgery, Medical University of Vienna, Division of Cardiac Surgery, Vienna, Austria, Währinger Gürtel 18-20, 1090 Vienna, Austria
  2. Division of Nuclear Medicine & Molecular Imaging, Long Island Jewish Medical Center, New Hyde Park, 270-05 76th Avenue, 11040 New York, United States
  3. Department of Orthopedic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Wien, Austria
  4. ISOTOPIX — Institute for Nuclear Medicine, Vienna, Mariannengasse 30, A-1090 Vienna, Austria
  5. Department of Nuclear Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria

open access

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

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.

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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)

Article type

Research paper

Pages

81-87

Published online

2017-05-25

Page views

1664

Article views/downloads

1527

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

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