Usefulness of 99mTc-ciprofloxacin scintigraphy in the diagnosis of prosthetic joint infections

David Fuster, Alex Soriano, Sebastian Garcia, Carlos Piera, Joan Suades, Dani Rodríguez, Juan C. Martinez, Josep Mensa, Francisco Campos, Francesca Pons

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26 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the usefulness of 99mTc-ciprofloxacin scintigraphy (CFS) in patients with hip or knee arthroplasty and suspected infection. METHODS: Forty patients (26 women, 14 men) with a mean age of 66±10 years and local pain in the hip (21), knee (16), or shoulder (three) prosthesis were recruited. CFS was performed at 1, 4, and 24 h after intravenous injection of 370 MBq. Anterior and posterior views centered on the affected joint were performed in all patients. A routine bone scan, 99mTc-hexamethylpropyleneamine oxime leukocyte scan, and Tc-colloid scan [leukocyte scintigraphy-bone marrow scintigraphy (LS-MS)] were performed. Final diagnosis of infection was confirmed by positive microbiological analysis or macroscopic evidence of purulent material. RESULTS: Diagnosis of arthroplasty infection was established in 16 out 40 cases: coagulase-negative staphylococci (nine), Staphylococcus aureus (three), Enterococcus (one), and macroscopic infection in the remaining three cases. CFS imaging showed the 24-h image to be the best acquisition time-point. The sensitivity, specificity, negative predictive value, and positive predictive value for LS-MS were 75, 92, 86, and 85%, whereas for CFS at 24 h these figures were 88, 71, 67, and 89%. The sensitivity and specificity for LS-MS and for CFS at 24 h for hip were (74, 90, and 88, 85%) and for knee (83, 90 and 100, 50%). CONCLUSION: CFS can be useful in the diagnosis of arthroplasty infection of the hip as a substitute for LS-MS. It is recommended that CFS images be obtained 24 h after injection. The lack of specificity of CFS makes this technique inadequate for knee prostheses in this series. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Original languageEnglish
Pages (from-to)44-51
JournalNuclear Medicine Communications
Volume32
Issue number1
DOIs
Publication statusPublished - 1 Jan 2011

Keywords

  • 99m Tc-ciprofloxacin
  • 99m Tc-hexamethylpropyleneamine oxime-leukocyte
  • bone marrow scintigraphy
  • joint prosthesis
  • osteoarticular infection

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