Comparison of the Three Phase Bone Scintigraphy and Tc-99m Ciprofloxacin Scintigraphy in Diagnosis of Septic and Aseptic Loosening of the Hip and Knee Prosthesis

Öz

Objective: In this study, the results of three phase bone scintigraphy and Tc-99m ciprofloxacin scintigraphy were assessed comparatively in the diagnosis of the septic and aseptic loosening of the hip and knee prosthesis. Materials and Methods: Fifty patients who were referred to our clinic with the pre-diagnosis of infection were included in the study. Thirty two of the patients (64%) had hip prosthesis and 18 (36%) had knee prosthesis. Three phase bone scintigraphy and Tc-99m ciprofloxacin scintigraphy were applied at least 3-5 days interval in our clinic. Results: Three phase bone scintigraphy was reported as positive for 23 patients (46%) and negative for 27 patients (54%) in terms of infection. Tc-99m ciprofloxacin scintigraphy was reported as positive for 19 (54%) and negative for 31 patients (62%). The sensitivity for the three phase bone scintigraphy was found to be 100%. It was 86.6% for the Tc-99m ciprofloxacin scintigraphy. Specificity was 77.5% versus 82.8% (p0,05); negative predictive value was 100% versus 93.5% (p0,05), respectively. Conclusion: Besides being a sensitive method, three phase bone scintigraphy can be used confidently in preventing from the infection existence. Since, the specifity of Tc-99m ciprofloxacin scintigraphy is higher when compared with the three phase bone scintigraphy; the usage of both method in the septic-aseptic loosening sorting is suitable.

Anahtar Kelimeler

• Septic and aseptic loosening, Bone scintigraphy, Ciprofloxacin scintigraphy

Kalça Ve Diz Protezlerindeki Septik ve Aseptik Gevşeme Tanısında Üç Fazlı Kemik Sintigrafisi ve Tc-99m Siprofloksasin Sintigrafisinin Karşılaştırılması

Öz

Amaç: Bu çalışmada kalça ve diz protezlerindeki septik-aseptik gevşeme ayırıcı tanısında üç fazlı kemik sintigrafisi ve Tc-99m siprofloksasin sintigrafisinin sonuçları karşılaştırmalı olarak değerlendirildi. Gereç ve Yöntem: Çalışmaya enfeksiyon ön tanısıyla kliniğimize yönlendirilen 50 hasta dahil edildi. Hastaların 32'sinde (% 64) kalça protezi, 18'inde (% 36) diz protezi mevcuttu. Hastalara en az 3-5 gün arayla üç fazlı kemik sintigrafisi ve Tc-99m siprofloksasin sintigrafisi çekildi. Bulgular: Üç fazlı kemik sintigrafisi, 23 (% 46) hastada enfeksiyon açısından pozitif, 27 (% 54) hastada ise enfeksiyon açısından negatif olarak rapor edildi. Tc99m siprofloksasin sintigrafisi; 19 (% 38) hastada pozitif, 31 (% 62) hastada negatif olarak rapor edildi. Üç fazlı kemik sintigrafisi için sensitivite % 100 iken Tc-99m siprofloksasin sintigrafisi için % 86.6 (p0.05); negatif prediktif değer % 100'e % 93.5 (p

Anahtar Kelimeler

• Septik-aseptik gevşeme, Kemik sintigrafisi, Siprofloksasin sintigrafisi

Kaynakça

1. Fitzgerald RH Jr., Jones DR. Hip implant infection. Treatment with Resection arthroplasty and late total hip arthroplasty. Am J Med 1985; 78: 225-8.
2. Britton KE, Vinjamuri S,Hall AV, et al. Clinical evaluation of Tc-99m infecton for the localization of bacterial infecton. Eur J Nucl Med 1997; 24: 553-6.
3. Sönmezoğlu K, Sönmezoğlu M, Halaç M, et al. Usefulness of Tc-99m ciprofloxacin (Infecton) scan in diagnosis of chronic orthopedic infections: comparative study with Tc-99m HMPAO leukocyte scintigraphy. J Nucl Med 2001; 42: 5677
4. Love C. Role of nuclear medicine in diagnosis of the infected joint replacement. Radiographics 2001; 21: 1229-38.
5. Palestro CJ. Nuclear medicine, the painful prosthetic joint, and orthopedic infection. J Nucl Med 2003; 44: 927-9.
6. Gomez-Luzuriaga MA, Galan V, Villar JM. Scintigraphy with Tc-99m, Ga-67 and in painful total hip prostheses. Int Orthop 1988; 12: 163-7.
7. Ooi GC, Belton I, Finlay D. Comparison of technetium 99mnanokolloid and indium 111 leucocytes in the diagnosis of orthopaedic infections. Br J Radiol 1993; 66: 1025-30.
8. Chianelli M, Mather SJ, Martin-Comin J et al. Radiopharmaceuticals for the study of inflammatory processes: a review. Nucl Med Commun 1997; 18: 437-55.

9. Nijhof M W, Oyen WJ, Van Kampen A, et al. Hip and knee arthroplasty infection. In-111-IgG scintigraphy in 102 cases. Acta Orthop Scand 1997; 68: 332-6.
10. Zhuang H, Duarte PS, Pourdehnad M, et al. The promising role of F18-FDG PET in detecting infected lower limb prosthesis implants. J Nucl Med 2001; 42: 44-8.
11. Weiss PE, Mall JC, Hoffer PB, et al. Tc-99m methylene diphosphonate bone imaging in the evaluation of total hip prostheses. Radiology 1979; 133: 727-9.
12. Rubello D, Borsato N, Chierichetti F, et al. Three-phase bone scintigraphy pattern of loosening in uncemented hip prostheses. Eur J Nucl Med 1995; 22: 299-301.
13. Rosenthall L.Hip and knee prostheses: evaluation of the natural history of periprosthetic bone changes. Semin Nucl Med 1997; 27: 346-54.
14. Lieberman JR, Huo MH, Schneider, et al. Evaluation of painful hip arthroplasties. Are technetium bone scans necessary? J Bone Joint Surg Br 1993; 75: 475-8.
15. Malamitsi J,Giamarellou H, Kanellakopoulou K ve ark. Infecton: a Tc-99m ciprofloxacinradiopharmaceutical for the detection of bone infection. Clin Microbiol Infect 2003; 9: 101
16. Yapar Z, Kibar M, Yapar AF, et al. The efficacy of technetium-99m ciprofloxacin (infecton) imaging in suspected orthopaedic infection: a comparison with sequential bone/gallium imaging. Eur J Nucl Med 2001; 28: 822-30.
17. Sarda L, Cremieux AC, Lebellec Y, et al. Inability of Tc-99m ciprofloxacin scintigraphy to discriminate between septic and sterile osteoarticular diseases. J Nucl Med 2003; 44: 920-6. Gönderilme Tarihi: 23.08.2012