Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis

Robert M Kwee*, Wouter Am Broos, Boudewijn Brans, Geert H.I.M. Walenkamp, Jan Geurts, René E Weijers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background
The diagnosis of infected hip prosthesis is frequently not straightforward yet very important as it changes treatment.

Purpose
To retrospectively investigate the added value of 18F-FDG PET/CT to conventional tests including radiography, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) testing, and joint aspiration, in diagnosing infected hip prosthesis.

Material and Methods
Seventy-eight hip prostheses of 78 patients (55% men; mean age = 66.5 years; age range = 30–85 years) with non-specific clinical presentation, i.e. no abscess or sinus tract communicating with the joint space at clinical examination, were analyzed. Cultures of intra-articular fluid and peri-implant tissues after revision surgery or clinical follow-up ≥6 months served as gold standard. Areas under the receiver operating characteristic curves (AUCs) of radiography, ESR/CRP testing, aspiration culture, and white blood cell (WBC) count without and with the addition of 18F-FDG PET/CT were compared.

Results
The addition of 18F-FDG PET/CT increased AUCs: for radiography with 0.212, P = 0.001; for ESR/CRP testing with 0.076, P = 0.072; for aspiration culture with 0.126, P = 0.032; and for aspiration WBC count with 0.191, P = 0.035.

Conclusion
This study shows that 18F-FDG PET/CT adds to individual conventional tests in diagnosing infected hip prosthesis. It may improve the preoperative planning and should therefore be considered in the diagnostic work-up. Future studies should define the exact place of 18F-FDG PET/CT in the diagnostic work-up of periprosthetic joint infection.
Original languageEnglish
Pages (from-to)569-576
Number of pages8
JournalActa Radiologica
Volume59
Issue number5
DOIs
Publication statusPublished - 1 May 2018

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