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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) The clinical contribution of SPECT/CT with 99mTc-HMPAO-labeled leukocyte scintig...
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Vol. 38. Issue 4.
Pages 212-217 (July - August 2019)
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Vol. 38. Issue 4.
Pages 212-217 (July - August 2019)
Original Article
The clinical contribution of SPECT/CT with 99mTc-HMPAO-labeled leukocyte scintigraphy in hip and knee prosthetic infections
Aportación clínica de la SPECT/TC en la gammagrafía con leucocitos marcados con 99mTc-HMPAO en infección de prótesis de cadera y rodilla
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Tarik Sengoza,
Corresponding author
tsengoz@pau.edu.tr

Corresponding author.
, Olga Yaylalia, Dogangun Yuksela, Fahir Demirkanb, Ozlem Uluyola
a Pamukkale University, Medical Faculty, Department of Nuclear Medicine, Denizli, Turkey
b Pamukkale University, Medical Faculty, Department of Orthopedics, Denizli, Turkey
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Table 1. Demographic characteristics and 99mTc-HMPAO-labeled leukocyte scintigraphy (planar and SPECT/CT) results in the prosthetic infection positive group.
Table 2. Demographic characteristics and 99mTc-HMPAO-labeled leukocyte scintigraphy (planar and SPECT/CT) results in the prosthetic infection negative group.
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Abstract
Objectives

White blood cell scanning with 99mTc-hexamethylpropylene amine oxime(HMPAO) has proven a sensitive and specific imaging method in the diagnosis of suspected prosthesis infection. The aim of this retrospective study was to evaluate the usefulness of SPECT/CT performed simultaneously using a hybrid imaging device of prosthesis infections.

Materials and methods

99mTc-HMPAO scintigraphy was performed on 37 patients (11 men and 26 women; age range 38-84 years; mean age±SD, 65.7±5.6 years). Planar scans were acquired 2.,4. and 24. hour after injection. SPECT/CT was obtained 4 h after injection, using a dual-head hybrid gama camera coupled with a low-power x-ray tube. In all patients, scintigraphic results were matched with the results of surgery, cultures and clinical follow-up.

Results

Seventeen (45,9%) out of 37 patients had prosthesis infection and 20 (54,1%) out of 37 patients had non-infectious prosthesis pathologies with 99mTc-HMPAO scintigraphy and SPECT/CT. The 99mTc-HMPAO scintigraphy was true-positive for infection in 16 of 37 patients and true-negative in 20 of 37 patients. SPECT/CT provided an accurate anatomic localization of all positive foci. With regard to the final diagnosis, SPECT/CT added a significant clinical contribution in 22 of 37 patients(59,4%). Sensitivity, specificity, negative predictive value(NPD) and positive predictive values(PPD) were 100%,59.1%,100%,62.5% in planar images with 99mTc-HMPAO scintigraphy and 100%,90.1%,100%,88.2% in the planar+SPECT/CT imaging, respectively.

Conclusion

Our results indicate that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO scintigraphy in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.

Keywords:
99mTc-HMPAO–labeled leukocyte scintigraphy
inflammation
SPECT
SPECT/CT
Resumen
Objetivo

La gammagrafía con leucocitos marcados con 99mTc-HMPAO ha resultado un método de estudio específico y altamente sensible en el diagnóstico y seguimiento de pacientes con sospecha de infección protésica. El objetivo de este estudio retrospectivo fue evaluar la utilidad de la SPECT/TC en infección protésica.

Material y métodos

Se realizó una gammagrafía con leucocitos marcados con 99mTc- HMPAO a 37 pacientes con prótesis articular (11 hombres y 26 mujeres; rango de edades de 38 a 84 años; edad media ±DE, 65.7±5.6 años). Se obtuvieron imágenes planares 2, 4 y 24 horas después de la inyección. A las 4 horas se realizó SPECT/TC usando una gammacámara híbrida de doble detector con TC de baja energía. En todos los pacientes se compararon los resultados de la gammagrafía con los resultados de la intervención quirúrgica, el cultivo y el seguimiento clínico.

Resultados

De 37 pacientes estudiados con leucocitos marcados con 99mTc-HMPAO, con gammagrafía y SPECT/TC, diecisiete (45,9%) tenían infección protésica, y 20 (54,1%) tenían patologías protésicas no infecciosas. La gammagrafía con leucocitos marcados con 99mTc-HMPAO fue verdadero positivo para infección en 16 de 37 pacientes y verdadero negativo en 20 de 37 pacientes. La SPECT/TC proporciona una localización anatómica precisa de todos los posibles focos. Considerando el diagnostico final, la SPECT/TC aportó una contribución clínica significativa en 22 de 37 pacientes (59,4%). La sensibilidad, especificidad, valor predictivo negative y valor predictivo positive fueron del 100%, 59.1%, 100%, 62.5% en las imágenes planares y de 100%, 90.1%, 100%, 88.2% en la imagen planar más SPECT/TC respectivamente.

Discusión

Nuestros resultados indican que la realización de la SPECT/TC puede mejorar el estudio con leucocitos marcados con 99mTc-HMPAO en pacientes con sospecha de osteomielitis, y proporcionar una localización anatómica y una definición precisa del alcance de la infección.

Palabras clave:
gammagrafía con leucocitos marcados con 99mTc-HMPAO, inflamación, SPECT, SPECT/CT

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