Abstract
The indications and potential use of FDG PET CT in prosthetic joint infection (PJI) have not evolved fully. Most studies have compared the accuracy of FDG PET/CT with clinical parameters and other biological and radiological markers. However, FDG PET CT can also guide tissue biopsy or aspiration to increase the yield and towards accurate diagnosis. FDG uptake in mid-shaft of the implant at the bone–prosthesis interface in hip arthroplasty or increased FDG uptake in the bone–prosthesis interface for knee arthroplasty compared with adjacent soft tissue are the usually accepted criteria for diagnosis of infection. Extra information can be actively sought for from FDG PET/CT beyond just classifying into infection present or not and include the presence of periosteal reaction, peri-prosthetic osteolysis, peri-prosthetic calcification, sinus tract description, localization of infection, extent of infection, involvement of joint space, stability of joint/prosthesis, the integrity of surrounding soft tissue etc. which can be of additional value in guiding the orthopedic surgeon in the management of these patients. If PJI is due to hematogenous spread of infection then, FDG PET/CT may additionally help in localization of distant source of infection. The heterogeneity of criteria, lack of specificity in diagnosis, and relatively lower yield of PET studies suggest that they should be examined further by larger prospective trials.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Steckelberg JM, Osmon DR. Prosthetic joint infections. In: Waldvogel FAB, Bisno AL, editors. Infections associated with indwelling medical devices. 3rd ed. Washington, DC: American Society for Microbiology; 2000. p. 173–209.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–54.
Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–9.
Sia IG, Berbari EF, Karchmer AW. Prosthetic joint infections. Infect Dis Clin N Am. 2005;19:885–914.
Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27(5):1247–54.
Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplast. 2014;29(7):1331.
Trampuz A, Steckelberg JM, Osmon DR, Cockerill FR, Hanssen AD, Patel R. Advances in the laboratory diagnosis of prosthetic joint infection. Rev Med Microbiol. 2003;14:1–14.
Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117:556–62.
Athanasou NA, Pandey R, de Steiger R, Crook D, Smith PM. Diagnosis of infection by frozen section during revision arthroplasty. J Bone Joint Surg Br. 1995;77:28–33.
Patel R, Alijanipour P, Parvizi J. Advancements in diagnosing periprosthetic joint infections after total hip and knee arthroplasty. Open Orthop J. 2016;10:654–61.
Basu S, Chryssikos T, Moghadam-Kia S, et al. Positron emission tomography as a diagnostic tool in infection: present role and future possibilities. Semin Nucl Med. 2009;39:36–51.
Basu S, Zhuang H, Torigian DA, et al. Functional imaging of inflammatory diseases using nuclear medicine techniques. Semin Nucl Med. 2009;39:124–45.
Kwee TC, Basu S, Torigian DA, et al. FDG-PET imaging for diagnosing prosthetic joint infection: discussing the facts, rectifying the unsupported claims and call for evidence-based and scientific approach. Eur J Nucl Med Mol Imaging. 2013;40:464–6.
Zhuang H, Duarte PS, Pourdehnad M, Maes A, Van Acker F, Shnier D, Garino JP, Fitzgerald RH, Alavi A. The promising role of 18F-FDG PET in detecting infectedlower limb prosthesis implants. J Nucl Med. 2001;42(1):44–8.
Chryssikos T, Parvizi J, Ghanem E, Newberg A, Zhuang H, Alavi A. FDG-PETimaging can diagnose periprosthetic infection of the hip. Clin Orthop Relat Res. 2008;466(6):1338–42.
Basu S, Kwee TC, Saboury B, Garino JP, Nelson CL, Zhuang H, Parsons M, Chen W, Kumar R, Salavati A, Werner TJ, Alavi A. 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 marrowimaging in 88 prostheses. Clin Nucl Med. 2014;39(7):609–15.
Mumme T, Reinartz P, Alfer J, Müller-Rath R, Buell U, Wirtz DC. Diagnosticvalues of positron emission tomography versus triple-phase bone scan in hiparthroplasty loosening. Arch Orthop Trauma Surg. 2005;125(5):322–9.
Delank KS, Schmidt M, Michael JW, Dietlein M, Schicha H, Eysel P. Theimplications of 18F-FDG PET for the diagnosis of endoprosthetic loosening andinfection in hip and knee arthroplasty: results from a prospective, blindedstudy. BMC Musculoskelet Disord. 2006;7:20.
Vanquickenborne B, Maes A, Nuyts J, Van Acker F, Stuyck J, Mulier M, Verbruggen A, Mortelmans L. The value of (18)FDG-PET for the detection ofinfected hip prosthesis. Eur J Nucl Med Mol Imaging. 2003;30(5):705–15.
Gravius S, Gebhard M, Ackermann D, Büll U, Hermanns-Sachweh B, Mumme T. Analysis of 18F-FDG uptake pattern in PET for diagnosis of aseptic looseningversus prosthesis infection after total knee arthroplasty. A prospective pilotstudy. Nuklearmedizin. 2010;49(3):115–23.
Chacko TK, Zhuang H, Stevenson K, Moussavian B, Alavi A. The importance of thelocation of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses. Nucl Med Commun. 2002;23(9):851–5.
Hao R, Yuan L, Kan Y, Yang J. 18F-FDG PET for diagnosing painful arthroplasty/prosthetic joint infection. Clin Transl Imaging. 2017;5(4):315–22. https://doi.org/10.1007/s40336-017-0237-8.
Zhuang H, Chacko TK, Hickeson M, Stevenson K, Feng Q, Ponzo F, et al. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty. Eur J Nucl Med Mol Imaging. 2002;29:1328–33.
Goerres GW, Ziegler SI, Burger C, Berthold T, Von Schulthess GK, Buck A. Artifacts at PET and PET/CT caused by metallic hip prosthetic material. Radiology. 2003;226(2):577–84.
Osman S, Danpure HJ. The use of 2-[18F]fluoro-2-deoxy-D-glucose as a potential in vitro agent for labelling human granulocytes for clinical studies by positron emission tomography. Int J Rad Appl Instrum B. 1992;19:183–90.
Dumarey N, Egrise D, Blocklet D, Stallenberg B, Remmelink M, del Marmol V, Van Simaeys G, Jacobs F, Goldman S. Imaging infection with 18F-FDG-labeled leukocyte PET/CT: initial experience in 21 patients. J Nucl Med. 2006;47(4):625–32.
Aksoy SY, Asa S, Ozhan M, Ocak M, Sager MS, Erkan ME, Halac M, Kabasakal L, Sönmezoglu K, Kanmaz B. FDG and FDG-labelled leucocyte PET/CT in the imaging ofprosthetic joint infection. Eur J Nucl Med Mol Imaging. 2014;41(3):556–64.
Basu S, Kwee TC, Hess S. FDG-PET/CT imaging of infected bones and prosthetic joints. Curr Mol Imaging. 2014;3(3):225–9.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Thapa, P., Kalshetty, A., Basu, S. (2018). FDG PET/CT in Assessment of Prosthetic Joint Infection. In: Wagner, T., Basu, S. (eds) PET/CT in Infection and Inflammation . Clinicians’ Guides to Radionuclide Hybrid Imaging(). Springer, Cham. https://doi.org/10.1007/978-3-319-90412-2_5
Download citation
DOI: https://doi.org/10.1007/978-3-319-90412-2_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90411-5
Online ISBN: 978-3-319-90412-2
eBook Packages: MedicineMedicine (R0)