99mTc-HMPAO-leukocyte scintigraphy in patients with symptomatic total hip or knee arthroplasty: Improved diagnostic accuracy by means of semiquantitative evaluation

Ettore Pelosi, Cinzia Baiocco, Michele Pennone, Giuseppe Migliaretti, Teresio Varetto, Agostino Maiello, Marilena Bellò, Gianni Bisi

Research output: Contribution to journalArticle

Abstract

The aim of this study was to evaluate the diagnostic value, in suspected infectious prostheses, of 99mTc-labeled hexamethylpropyleneamine oxime (99mTc-HMPAO) leukocyte scintigraphy interpreted with the addition of a semiquantitative analysis. Methods: By means of a retrospective review, we included a group of 78 consecutive patients with suspected hip or knee prosthesis infection. We performed 91 99mTc-HMPAO-leukocyte scintigraphies and examined 95 localizations that were suspect. Images were acquired at 3 different time points after the injection of the labeled leukocytes: 50 min (early images), 4 h, and 24 h (late images). The scintigraphic examinations were independently evaluated by 3 observers; qualitative and semiquantitative analyses were performed. The final diagnosis of infection was based on surgical, histologic, and bacteriologic data and follow-up. Results: On qualitative analysis, sensitivity, specificity, and accuracy were 80.4%-87%, 65.3%-71.4%, and 75.8%-77.9%, respectively. On semiquantitative analysis, sensitivity, specificity, and accuracy were 95.6%, 95.8%, and 95.8%, respectively. The analysis of 95% confidential intervals showed statistically significant differences in specificity and accuracy between semiquantitative and qualitative analyses. Conclusion: In those patients who underwent 99mTc-HMPAO-leukocyte scintigraphy for suspected hip or knee prosthesis infection, the addition of a semiquantitative evaluation to the qualitative analysis of early and late images leads to a significant improvement in both specificity and accuracy.

Original languageEnglish
Pages (from-to)438-444
Number of pages7
JournalJournal of Nuclear Medicine
Volume45
Issue number3
Publication statusPublished - Mar 1 2004

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Knee Replacement Arthroplasties
Radionuclide Imaging
Hip
Leukocytes
Knee Prosthesis
Hip Prosthesis
Infection
Sensitivity and Specificity
Prostheses and Implants
Injections
hexamethylpropyleneamine oxime

Keywords

  • Tc-labeled leukocytes
  • Hip prosthesis
  • Infection radionuclide imaging
  • Knee prosthesis

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

99mTc-HMPAO-leukocyte scintigraphy in patients with symptomatic total hip or knee arthroplasty : Improved diagnostic accuracy by means of semiquantitative evaluation. / Pelosi, Ettore; Baiocco, Cinzia; Pennone, Michele; Migliaretti, Giuseppe; Varetto, Teresio; Maiello, Agostino; Bellò, Marilena; Bisi, Gianni.

In: Journal of Nuclear Medicine, Vol. 45, No. 3, 01.03.2004, p. 438-444.

Research output: Contribution to journalArticle

Pelosi, E, Baiocco, C, Pennone, M, Migliaretti, G, Varetto, T, Maiello, A, Bellò, M & Bisi, G 2004, '99mTc-HMPAO-leukocyte scintigraphy in patients with symptomatic total hip or knee arthroplasty: Improved diagnostic accuracy by means of semiquantitative evaluation', Journal of Nuclear Medicine, vol. 45, no. 3, pp. 438-444.
Pelosi, Ettore ; Baiocco, Cinzia ; Pennone, Michele ; Migliaretti, Giuseppe ; Varetto, Teresio ; Maiello, Agostino ; Bellò, Marilena ; Bisi, Gianni. / 99mTc-HMPAO-leukocyte scintigraphy in patients with symptomatic total hip or knee arthroplasty : Improved diagnostic accuracy by means of semiquantitative evaluation. In: Journal of Nuclear Medicine. 2004 ; Vol. 45, No. 3. pp. 438-444.
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abstract = "The aim of this study was to evaluate the diagnostic value, in suspected infectious prostheses, of 99mTc-labeled hexamethylpropyleneamine oxime (99mTc-HMPAO) leukocyte scintigraphy interpreted with the addition of a semiquantitative analysis. Methods: By means of a retrospective review, we included a group of 78 consecutive patients with suspected hip or knee prosthesis infection. We performed 91 99mTc-HMPAO-leukocyte scintigraphies and examined 95 localizations that were suspect. Images were acquired at 3 different time points after the injection of the labeled leukocytes: 50 min (early images), 4 h, and 24 h (late images). The scintigraphic examinations were independently evaluated by 3 observers; qualitative and semiquantitative analyses were performed. The final diagnosis of infection was based on surgical, histologic, and bacteriologic data and follow-up. Results: On qualitative analysis, sensitivity, specificity, and accuracy were 80.4{\%}-87{\%}, 65.3{\%}-71.4{\%}, and 75.8{\%}-77.9{\%}, respectively. On semiquantitative analysis, sensitivity, specificity, and accuracy were 95.6{\%}, 95.8{\%}, and 95.8{\%}, respectively. The analysis of 95{\%} confidential intervals showed statistically significant differences in specificity and accuracy between semiquantitative and qualitative analyses. Conclusion: In those patients who underwent 99mTc-HMPAO-leukocyte scintigraphy for suspected hip or knee prosthesis infection, the addition of a semiquantitative evaluation to the qualitative analysis of early and late images leads to a significant improvement in both specificity and accuracy.",
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AU - Migliaretti, Giuseppe

AU - Varetto, Teresio

AU - Maiello, Agostino

AU - Bellò, Marilena

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N2 - The aim of this study was to evaluate the diagnostic value, in suspected infectious prostheses, of 99mTc-labeled hexamethylpropyleneamine oxime (99mTc-HMPAO) leukocyte scintigraphy interpreted with the addition of a semiquantitative analysis. Methods: By means of a retrospective review, we included a group of 78 consecutive patients with suspected hip or knee prosthesis infection. We performed 91 99mTc-HMPAO-leukocyte scintigraphies and examined 95 localizations that were suspect. Images were acquired at 3 different time points after the injection of the labeled leukocytes: 50 min (early images), 4 h, and 24 h (late images). The scintigraphic examinations were independently evaluated by 3 observers; qualitative and semiquantitative analyses were performed. The final diagnosis of infection was based on surgical, histologic, and bacteriologic data and follow-up. Results: On qualitative analysis, sensitivity, specificity, and accuracy were 80.4%-87%, 65.3%-71.4%, and 75.8%-77.9%, respectively. On semiquantitative analysis, sensitivity, specificity, and accuracy were 95.6%, 95.8%, and 95.8%, respectively. The analysis of 95% confidential intervals showed statistically significant differences in specificity and accuracy between semiquantitative and qualitative analyses. Conclusion: In those patients who underwent 99mTc-HMPAO-leukocyte scintigraphy for suspected hip or knee prosthesis infection, the addition of a semiquantitative evaluation to the qualitative analysis of early and late images leads to a significant improvement in both specificity and accuracy.

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