Use of PET-CT in diagnostic workup of periprosthetic infection of hip and knee joints: significance in detecting additional infectious focus

Abstract Introduction The diagnosis and management of periprosthetic knee and hip infections as well as the identification and management of possible additional infectious foci is of great importance for successful therapy. This study analyses the importance of 18F deoxyglucose PET-CT (PET-CT) in the identification of additional infectious focus and subsequent impact on management of periprosthetic infection (PPI). Material and methods A retrospective analysis of the clinical data and findings in the period from January 2008 to December 2018 was carried out. One hundred and four patients with in-hospital treatment due to PPI of a hip or knee joint were identified and included in this study. All patients underwent a standardized clinical examination and further surgical and antibiotic therapy. The reevaluation of performed PET-CTs was specifically carried out with regard to the local PPI or detection of secondary foci. Results PET-CT successfully verified the PPI in 84.2% of the patients. A total of 78 possible additional foci were detected in PET-CT in 56 (53.8%) of the examined patients. Predilection sites for possible secondary foci were joints (42.3%), pulmonary (15.4%), ear-nose-throat (15.4%), spine (11.5%), and the musculocutaneous tissues (11.5%). Fifty-four positive PET-CT findings were confirmed clinically with need of additional adequate treatment. Conclusion PET-CT is a valuable diagnostic tool to confirm periprosthetic joint infection. At the same time, the whole-body PET/CT may detect additional foci of infection with impact on subsequent treatment strategy. PET was of special value in detecting infections at distant locations far from the primary infected joint in significant number. These distant infection locations can be potential cause of a re-infection. This clearly reflects the need of their diagnosis.

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Clinical and microbiological characteristics of periprosthetic hip and knee infections

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2020.3.237-240 ◽

2020 ◽

pp. 237-240

Author(s):

Vladimir A. Ivantsov ◽

I.P. Bogdanovich ◽

V.V. Lashkovskiy ◽

V.S. Anosov

Keyword(s):

Surgical Treatment ◽

Knee Joint ◽

Hip Joint ◽

Joint Replacement ◽

Periprosthetic Infection ◽

Joint Infection ◽

Knee Joints ◽

Knee Joint Replacement ◽

Hip Joint Replacement ◽

Total Knee

Objective. To characterize periprosthetic joint infection in patients undergoing a total hip and knee joint replacement. Materials and Methods. A total of 77 patients with periprosthetic infection following hip and knee joint replacement hospitalized in Grodno City Clinical Hospital were studied over the period of 2014-2018. Wound discharge, tissue samples, and fistula’s wall swab were used for microbiological tests. The analysis of surgical treatment of patients with deep periprosthetic knee and hip joint infection has been performed. Results. Periprosthetic infection after hip joint arthroplasty was observed in 32 (41.6%) patients, and after total knee joint arthroplasty in 45 (58.4%) patients. Surgical treatment was performed in 18 (56.3%) and 32 (71.1%) patients with periprosthetic infection following total knee and hip joint replacement, respectively. A total of 10 (31.2%) of 32 cultures from patients with periprosthetic infection after total hip joint replacement and 8 (17.8%) of 45 cultures from patients with periprosthetic infection after total knee joint replacement were positive. Overall, Staphylococcus aureus was detected in 9 (50%) of 18 positive cultures. Gram-negative aerobic bacteria (Acinetobacter baumannii, Klebsiella pneumoniae Pseudomonas aeruginosa) were detected in 4⁄10 and 5⁄8 of positive cultures from patients with periprosthetic infection of hip and knee joints, respectively. Conclusions. The most common pathogens causing periprosthetic infection of hip and knee joints were S. aureus (50%) and Gram-negative bacteria. The surgical treatment was performed in 71.4% of patients with periprosthetic joint infection.

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Brucella Periprosthetic Joint Infection Involving Bilateral Knees with Negative Synovial Fluid Alpha-Defensin

Case Reports in Infectious Diseases ◽

10.1155/2019/9423946 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Abdullah Balkhair ◽

Sultan Al Maskari ◽

Shadin Ibrahim ◽

Ibrahim Al Busaidi ◽

Mohammed Al Amin ◽

...

Keyword(s):

Synovial Fluid ◽

Periprosthetic Joint Infection ◽

Periprosthetic Infection ◽

Joint Infection ◽

Knee Joints ◽

Human Brucellosis ◽

Prosthetic Joint ◽

Possible Cause ◽

Microbiological Cure ◽

Rule Out

Periprosthetic joint infection (PJI) due to Brucella is uncommon despite relatively high endemicity of human brucellosis and its osteoarticular predilection. We report a case of a 57-year-old woman with bacteraemic brucellosis complicated by Brucella periprosthetic infection of both knee joints occurring a decade after bilateral knee arthroplasty and associated with a negative synovial fluid alpha-defensin test. The patient was successfully treated with anti-Brucella therapy alone and without surgical revision, resulting in clinical and microbiological cure. We propose that Brucella should be considered as a possible cause of prosthetic joint infection in the appropriate clinical and epidemiological settings. A negative synovial fluid alpha-defensin (Synovasure AD test) should not be used as a rule-out test for Brucella PJI. Brucella PJI without radiological loosening may be treated conservatively and solely with antimicrobial therapy.

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Immunity status in patients with periprosthetic knee joint infection

10.1101/2021.08.23.21261316 ◽

2021 ◽

Author(s):

Irina A. Mamonova ◽

Irina. V. Babushkina ◽

Aleksandr S. Bondarenko ◽

Vladimir Yu. Ulyanov

Keyword(s):

Knee Joint ◽

Immune Status ◽

Periprosthetic Infection ◽

Joint Infection ◽

False Negative ◽

Knee Joints ◽

Clinical Aspects ◽

Total Replacement ◽

Knee Joint Infection ◽

Diagnostic Approaches

AbstractImplant-associated infection is one of the most severe complications after total replacement of larger joints. The diagnosis of periprosthetic infection are often impeded as 5-34% of bacteriological tests are false-negative. Now the investigations of the immune status of patients suspected of periprosthetic infection are considered perspective as these are aimed at finding the most significant indicators for underlying the diagnosis of this pathology. In this research, we assessed immunology indicators in peripheral blood of patients with periprosthetic infection in their knee joints. We determined immunology characteristics associated with the clinical aspects of the progressing pathology. Our findings can be used as the basis for further search of pathophysiological mechanisms of periprosthetic infection progress in the knee joint as well as defining new diagnostic approaches.Reviewers:Ivanov A.N., MD, DSc;Prof. Puchinyan D.M., MD, DSc

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PET/CT

Nuklearmedizin ◽

10.1055/s-0038-1625216 ◽

2005 ◽

Vol 44 (S 01) ◽

pp. S51-S57 ◽

Cited By ~ 12

Author(s):

T. Beyer ◽

G. Brix

Keyword(s):

Diagnostic Accuracy ◽

Radiation Exposure ◽

Dose Reduction ◽

Pet Imaging ◽

Clinical Studies ◽

Review Article ◽

Whole Body ◽

High Radiation ◽

Radiation Burden ◽

Pet Ct

Summary:Clinical studies demonstrate a gain in diagnostic accuracy by employing combined PET/CT instead of separate CT and PET imaging. However, whole-body PET/CT examinations result in a comparatively high radiation burden to patients and thus require a proper justification and optimization to avoid repeated exposure or over-exposure of patients. This review article summarizes relevant data concerning radiation exposure of patients resulting from the different components of a combined PET/CT examination and presents different imaging strategies that can help to balance the diagnostic needs and the radiation protection requirements. In addition various dose reduction measures are discussed, some of which can be adopted from CT practice, while others mandate modifications to the existing hardand software of PET/CT systems.

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Reducing [ 18 F]FDG activity levels for whole-body PET/CT examinations of children

10.1055/s-0040-1708302 ◽

2020 ◽

Author(s):

H Kertesz ◽

T Beyer ◽

T Traub-Weidinger ◽

J Cal-Gonzalez ◽

M Hacker ◽

...

Keyword(s):

Whole Body ◽

Activity Levels ◽

Pet Ct

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Whole-Body PET-CT

e-Anatomy ◽

10.37019/e-anatomy/159099 ◽

2008 ◽

Author(s):

Antoine Micheau ◽

Denis Hoa

Keyword(s):

Whole Body ◽

Pet Ct

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PET/CT WITH 68GA-PSMA-11 IN DETECTION OF PRIMARY TUMOR AND RECURRENCE OF PROSTATE CANCER

Problems in oncology ◽

10.37469/0507-3758-2018-64-6-799-804 ◽

2018 ◽

Vol 64 (6) ◽

pp. 799-804

Author(s):

Darya Ryzhkova ◽

M. Poyda

Keyword(s):

Prostate Cancer ◽

Primary Tumor ◽

Biochemical Recurrence ◽

Whole Body ◽

Negative Results ◽

Primary Prostate Cancer ◽

Pet Ct ◽

The Relationship ◽

Positive Results ◽

T Category

Purpose: To study the diagnostic value of PET-CT with 68Ga-PSMA-11 in the diagnosis of a primary prostate cancer, preoperative staging, and the detection of recurrence of prostate cancer (PCa). Methods: 28 patients aged 64.7 ± 8.74 years were included. 10 patients primary prostate cancer, and 18 patients with biochemical recurrence of the disease after radical treatment were examined. All patients underwent PET-CT with 68Ga-PSMA-11 according the whole body protocol. Interpretation of images was performed visually and quantitatively by calculation of SUL max. Results: High focal or diffuse 68Ga-PSMA-11 uptake was found in prostate parenchyma in patients with primary prostate cancer. Additionally metastases in regional lymph nodes were diagnosed in 4 patients and bone metastases were found in one patient. The correlation between 68Ga-PSMA-11 uptake level and Gleason index in the primary tumor (R Spearmen = 0.25, p = 0.57) was not observed. PET-positive results were obtained in 14 patients and PET-negative results in 4 patients with biochemical recurrence of PCa. The relationship between the frequency of PET-positive results and Gleason index was not revealed (R Spearmen = 0.2, p = 0.39). We found a weak but significant correlation between the frequency of PET-positive results and the prostate tumor stage according to the T category (R Spearmen = 0.49, p = 0.049). In patients with low values of PSA (less than 1.0 ng/ml) in 4 out of 9 cases, PET-negative results were obtained. In patients with PSA level more than 1.0 ng/ml PET-positive results were obtained in all cases. Conclusions: PET/CT with 68Ga-PSMA-11 allows to diagnose the primary prostate cancer, to establish the stage of the disease in categories N and M, and also to determine the localization and dissemination of the tumor in patients with biochemical recurrence of prostate cancer. The relationship between 68Ga-PSMA-11 uptake in primary tumor and Gleason index was not found. The probability of obtaining PET-positive results in cases of biochemical recurrence is affected by a PSA level above 1 ng/ml and a high stage of the disease according to the T category (T3-T4).

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P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽

10.1017/cem.2020.222 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S69-S69

Author(s):

V. Tsang ◽

K. Bao ◽

J. Taylor

Keyword(s):

Systematic Review ◽

Incidental Findings ◽

Traffic Accidents ◽

Road Traffic ◽

Subsequent Treatment ◽

Whole Body ◽

Trauma Patients ◽

Patient Demographics ◽

Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

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Prospective study of dynamic whole-body 68Ga-DOTATOC-PET/CT acquisition in patients with well-differentiated neuroendocrine tumors

Scientific Reports ◽

10.1038/s41598-021-83965-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Philippe Thuillier ◽

David Bourhis ◽

Jean Philippe Metges ◽

Romain Le Pennec ◽

Karim Amrane ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Linear Relation ◽

Whole Body ◽

Pet Ct ◽

Non Linear ◽

Well Differentiated ◽

Analog Systems ◽

Pet System ◽

Dynamic Acquisition ◽

Linear Regressions

AbstractTo present the feasibility of a dynamic whole-body (DWB) 68Ga-DOTATOC-PET/CT acquisition in patients with well-differentiated neuroendocrine tumors (WD-NETs). Sixty-one patients who underwent a DWB 68Ga-DOTATOC-PET/CT for a histologically proven/highly suspected WD-NET were prospectively included. The acquisition consisted in single-bed dynamic acquisition centered on the heart, followed by the DWB and static acquisitions. For liver, spleen and tumor (1–5/patient), Ki values (in ml/min/100 ml) were calculated according to Patlak's analysis and tumor-to-liver (TLR-Ki) and tumor-to-spleen ratios (TSR-Ki) were recorded. Ki-based parameters were compared to static parameters (SUVmax/SUVmean, TLR/TSRmean, according to liver/spleen SUVmean), in the whole-cohort and according to the PET system (analog/digital). A correlation analysis between SUVmean/Ki was performed using linear and non-linear regressions. Ki-liver was not influenced by the PET system used, unlike SUVmax/SUVmean. The regression analysis showed a non-linear relation between Ki/SUVmean (R2 = 0.55,0.68 and 0.71 for liver, spleen and tumor uptake, respectively) and a linear relation between TLRmean/TLR-Ki (R2 = 0.75). These results were not affected by the PET system, on the contrary of the relation between TSRmean/TSR-Ki (R2 = 0.94 and 0.73 using linear and non-linear regressions in digital and analog systems, respectively). Our study is the first showing the feasibility of a DWB 68Ga-DOTATOC-PET/CT acquisition in WD-NETs.

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Multi-task weak supervision enables anatomically-resolved abnormality detection in whole-body FDG-PET/CT

Nature Communications ◽

10.1038/s41467-021-22018-1 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Sabri Eyuboglu ◽

Geoffrey Angus ◽

Bhavik N. Patel ◽

Anuj Pareek ◽

Guido Davidzon ◽

...

Keyword(s):

Fdg Pet ◽

Location Estimation ◽

Supervised Machine Learning ◽

Whole Body ◽

Free Text ◽

Abnormality Detection ◽

Weak Supervision ◽

Radiology Reports ◽

Pet Ct ◽

Fdg Pet Ct

AbstractComputational decision support systems could provide clinical value in whole-body FDG-PET/CT workflows. However, limited availability of labeled data combined with the large size of PET/CT imaging exams make it challenging to apply existing supervised machine learning systems. Leveraging recent advancements in natural language processing, we describe a weak supervision framework that extracts imperfect, yet highly granular, regional abnormality labels from free-text radiology reports. Our framework automatically labels each region in a custom ontology of anatomical regions, providing a structured profile of the pathologies in each imaging exam. Using these generated labels, we then train an attention-based, multi-task CNN architecture to detect and estimate the location of abnormalities in whole-body scans. We demonstrate empirically that our multi-task representation is critical for strong performance on rare abnormalities with limited training data. The representation also contributes to more accurate mortality prediction from imaging data, suggesting the potential utility of our framework beyond abnormality detection and location estimation.

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