Comparison of F18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Dynamic Contrast-Enhanced Magnetic Resonance Imaging as Markers of Graft Viability in Anterior Cruciate Ligament Reconstruction.
Am J Sports Med
; 47(1): 88-95, 2019 01.
Article
em En
| MEDLINE
| ID: mdl-30481047
ABSTRACT
BACKGROUND:
F18-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) can be used to assess changes in the metabolism of an anterior cruciate ligament (ACL) graft as it is undergoing "ligamentization." Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the preferred modality for noninvasive assessment of graft structure and graft vascularity.PURPOSE:
To compare the use of F18-FDG PET/CT and DCE-MRI to assess ligamentization within the ACL graft and correlate the results with clinical tests. STUDYDESIGN:
Case series; Level of evidence, 4.METHODS:
Among 30 recruited patients, 27 patients (3 females and 24 males) completed 2 follow-up assessments at a mean of 125 ± 22 days and 259 ± 38 days after arthroscopic ACL reconstruction. At both assessments, anterior drawer test, Lachman test, and Lysholm scoring (LS) were conducted. Images from F18-FDG PET/CT and MRI were analyzed qualitatively and quantitatively (maximum standardized uptake value [SUVmax], SUVmax ratio to the contralateral side [SUVmax CL], normalized enhancement [NE]) in 3 zones femoral, intra-articular (IA), and tibial. Of the 27 recruited patients, 1 patient had reinjury due to a fall. Therefore, 26 patients were considered for the final analysis.RESULTS:
A significant improvement ( P = .0001) was found in median LS, from 78.5 (range, 62-90) to 94.5 (range, 84-100), at the second follow-up. All grafts were found to be viable on PET/CT and vascularized on MRI. All grafts were seen as continuous on MRI, with exception of 1 graft at the second follow-up. Dynamic MRI identified single-vessel supply to all of the grafts at the first follow-up and multiple-vessel supply in 10 patients at the second follow-up. Reduction in the median SUVmax, SUVmax CL, and NE at second follow-up was seen in all 3 zones. Only SUVmax CL in the IA zone showed a significant reduction ( P = .032); patients with excellent LS at the second follow-up showed significantly higher reduction ( P = .005) than patients with good LS. NE in the IA zone was correlated (0.39; P = .048) with LS only at the first follow-up, whereas SUVmax CL (-0.52; P = .006) and SUVmax (-0.49, P = .010) in the IA zone negatively correlated with LS at the second follow-up only. No correlation was observed between PET/CT and MRI parameters.CONCLUSION:
Glucose metabolism and vascularity in the graft tissue can be used to assess ligamentization of ACL graft. A viable and vascularized graft at first follow-up is associated with good to excellent final outcome, regardless of LS at this stage. Since no correlation was observed between PET/CT and MRI parameters, they may be assessing different domains of the same process. Higher NE in the IA zone at the first follow-up and lower SUVmax CL in the same region at second follow-up are associated with better outcome.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Imageamento por Ressonância Magnética
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Ligamento Cruzado Anterior
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Reconstrução do Ligamento Cruzado Anterior
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Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Am J Sports Med
Ano de publicação:
2019
Tipo de documento:
Article