18F-FDG uptake in non-infected total hip prostheses

Gelderman, S. (Stefan) (2017) 18F-FDG uptake in non-infected total hip prostheses. thesis, Medicine.

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Abstract

Introduction: Diagnosing a prosthetic joint infection (PJI) can be difficult. Several imaging modalities are available, but the choice which technique to use is often based on local expertise, availability and costs. Some centers prefer to use 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) as first imaging modality of choice, but due to a lack of accurate interpretation criteria, FDG-PET scan is currently not routinely applied for diagnosing PJI. With FDG-PET it is difficult to differentiate between FDG uptake due to reactive inflammation and uptake due to an infection. Since the physiological uptake pattern around a joint prosthesis is not fully elucidated, the aim of this study was: i) to evaluate whether there is a difference in uptake between cemented and non-cemented prostheses, and ii) to determine the FDG uptake pattern in non-infected total hip prostheses. Material and Methods: Patients with a primary total hip arthroplasty (1995-2016) without clinical signs of a PJI that underwent an FDG-PET for another indication were included in the study and retrospectively analysed. Patients in whom the prosthesis was implanted < 6 months prior to FDG-PET were excluded, to avoid post-surgical FDG uptake. Scans were visually and quantitatively analysed. Quantitative analysis was performed by calculating maximum and peak standardized uptake values (SUVmax and SUVpeak) by volume of interests (VOIs) at eight different locations around the prosthesis, from which the mean SUV was calculated. SUV was standardized by the liver SUV that was taken as background. Results: A total of 51 scans from 28 patients were analysed. There was a difference in FDG uptake between the cemented (median SUVmax: 0.86, IQR: 0.77-1.05) and the uncemented prostheses (median SUVmax: 1.01, IQR: 0.85-2.02) (p = 0.026). In uncemented prostheses, there was a positive correlation in time between the age of the prosthesis and the FDG uptake (rs = 0.663, p = 0.004). This observation was not found in cemented prostheses (rs= 0.036, p = 0.847). The cemented prostheses showed mostly (87.5%) a diffuse uptake pattern around the prosthesis. In uncemented prostheses the same uptake pattern was predominantly seen (84.2%). In both prostheses the uptake is seen mostly around the neck of the prosthesis. Conclusion: These findings may add in the development of accurate interpretation criteria to better differentiate between inflammation and infection in patients with a prosthetic joint.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty Supervisor and Glaudemans, Dr. Andor W.J.M. and Second Supervisor and Wouthuyzen-Bakker, Dr. Marjan and Location UMCG, Department of Nuclear Medicine and Molecular and Department of medical microbiology
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:45
Last Modified:	25 Jun 2020 10:45
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/619

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