Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience.

IF 1.8 Q3 INFECTIOUS DISEASES
Journal of Bone and Joint Infection Pub Date : 2022-01-06 eCollection Date: 2022-01-01 DOI:10.5194/jbji-7-1-2022
Karsten D Ottink, Stefan J Gelderman, Marjan Wouthuyzen-Bakker, Joris J W Ploegmakers, Andor W J M Glaudemans, Paul C Jutte
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引用次数: 0

Abstract

Background: A low-grade periprosthetic joint infection (PJI) may present without specific symptoms, and its diagnosis remains a challenge. Three-phase bone scintigraphy (TPBS) and white blood cell (WBC) scintigraphy are incorporated into recently introduced diagnostic criteria for PJI, but their exact value in diagnosing low-grade PJI in patients with nonspecific symptoms remains unclear. Methods: In this retrospective study, we evaluated patients with a prosthetic joint of the hip or knee who underwent TPBS and/or WBC scintigraphy between 2009 and 2016 because of nonspecific symptoms. We reviewed and calculated diagnostic accuracy of the TPBS and/or WBC scintigraphy to diagnose or exclude PJI. PJI was defined based on multiple cultures obtained during revision surgery. In patients who did not undergo revision surgery, PJI was ruled out by clinical follow-up of at least 2 years absent of clinical signs of infection based on MSIS 2011 criteria. Results: A total of 373 patients were evaluated, including 340 TPBSs and 142 WBC scintigraphies. Thirteen patients (3.5 %) were diagnosed with a PJI. TPBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were 71 %, 65 %, 8 % and 98 %, respectively. Thirty-five percent of TPBS showed increased uptake. Stratification for time intervals between the index arthroplasty and the onset of symptoms did not alter its diagnostic accuracy. WBC scintigraphy sensitivity, specificity, PPV and NPV were 30 %, 90 %, 25 % and 94 %, respectively. Conclusion: Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection.

Abstract Image

对于先验假体周围关节感染几率较低的患者,核成像没有明显的附加价值。回顾性单中心经验。
背景:低度假体周围关节感染(PJI)可能没有特殊症状,其诊断仍是一个难题。三相骨闪烁成像(TPBS)和白细胞闪烁成像已被纳入最近推出的 PJI 诊断标准,但它们在诊断无特异性症状的低级别 PJI 患者中的确切价值仍不明确。方法:在这项回顾性研究中,我们对 2009 年至 2016 年间因非特异性症状而接受 TPBS 和/或 WBC 闪烁扫描的髋关节或膝关节假体患者进行了评估。我们回顾并计算了 TPBS 和/或白细胞闪烁扫描诊断或排除 PJI 的诊断准确性。PJI的定义基于翻修手术中获得的多次培养结果。对于未接受翻修手术的患者,根据 MSIS 2011 标准,通过临床随访至少 2 年且无感染临床表现,即可排除 PJI。结果:共对 373 例患者进行了评估,包括 340 例 TPBS 和 142 例白细胞闪烁扫描。有 13 名患者(3.5%)被诊断为 PJI。TPBS 的敏感性、特异性、阳性预测值和阴性预测值(PPV、NPV)分别为 71%、65%、8% 和 98%。35%的TPBS吸收率有所提高。对指数关节成形术和症状出现之间的时间间隔进行分层并不会改变其诊断准确性。白细胞闪烁扫描的敏感性、特异性、PPV 和 NPV 分别为 30%、90%、25% 和 94%。结论对于先验假体周围关节感染几率较低的患者,核成像没有明显的附加价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
29
审稿时长
12 weeks
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