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Bloodpool SPECT as part of bone SPECT/CT in painful total knee arthroplasty (TKA): validation and potential biomarker of prosthesis biomechanics

  • Jolien Verschueren
  • Adrien Albert
  • Laurens Carp
  • Sarah Ceyssens
  • Ivan Huyghe
  • Sigrid Stroobants
  • Frédéric Paycha
  • Gopinath Gnanasegaran
  • Tim Van den WyngaertEmail author
Original Article
  • 299 Downloads

Abstract

Purpose

To compare bloodpool SPECT with planar imaging in bone SPECT/CT of painful total knee arthroplasty (TKA) with respect to inter-rater agreement, confidence, prosthesis outcome, and biomechanical functioning.

Methods

Retrospective study of bloodpool SPECT and planar control images. Four raters used the validated Bruderholz scheme and a 5-point scale to grade uptake. Inter-rater agreement and overall confidence scores were calculated. Variable cluster analysis was performed to identify patterns of uptake, and associations between patterns and prosthesis outcome and biomechanical functioning were examined.

Results

In all, 55 knees in 43 patients were analyzed (median follow-up 17 months; revision rate 21.8%). SPECT significantly improved inter-rater agreement in 24% of regions (all P < 0.05) and overall confidence by 20% (P < 0.001). Regional uptake cluster analysis showed improved antero-posterior separation with SPECT, and distinct patterns associated with prosthesis survival in lateral femoral (P = 0.041) and medial tibial (P < 0.001) regions. The prognostic value of SPECT outperformed planar imaging for tibial (P < 0.001), patellar (P = 0.009), and synovial (P = 0.040) assessment. Internal femoral malrotation resulted in increased uptake in posteromedial (P = 0.042) and anterolateral (P = 0.016) femoral, and lateral patellar (P = 0.011) regions. Internal tibial malrotation increased uptake in posterolateral (P = 0.026) and posteromedial tibial (P = 0.005), and medial patellar regions (P = 0.004). Bloodpool SPECT improved the prognostic value of late-phase SPECT/CT for the assessment of the medial tibial region.

Conclusions

Bloodpool SPECT outperforms planar assessment of painful TKAs and the identification of distinct uptake patterns make it a potentially clinically relevant biomarker of prosthesis survival and biomechanical functioning.

Keywords

SPECT/CT SPECT Bloodpool Bone scintigraphy Total knee arthroplasty 

Notes

Funding

This study was funded by the Department of Nuclear Medicine of the Antwerp University Hospital.

Compliance with ethical standards

Ethical approval

All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Conflict of interest

The authors report no conflict of interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jolien Verschueren
    • 1
  • Adrien Albert
    • 2
  • Laurens Carp
    • 2
    • 3
  • Sarah Ceyssens
    • 2
    • 3
  • Ivan Huyghe
    • 2
    • 3
  • Sigrid Stroobants
    • 2
    • 3
  • Frédéric Paycha
    • 4
  • Gopinath Gnanasegaran
    • 5
  • Tim Van den Wyngaert
    • 2
    • 3
    Email author
  1. 1.Department of Nuclear Medicine and Molecular ImagingUniversity Hospital LeuvenLeuvenBelgium
  2. 2.Department of Nuclear MedicineAntwerp University HospitalEdegemBelgium
  3. 3.Faculty of Medicine and Health SciencesUniversity of AntwerpWilrijkBelgium
  4. 4.Department of Nuclear Medicine, Hôpital LariboisièreAssistance Publique-Hôpitaux de ParisParisFrance
  5. 5.Department of Nuclear MedicineRoyal Free London NHS Foundation TrustLondonUK

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