Added value of three-phase bone scintigraphy combined with SPECT/CT for differential diagnosis of periprosthetic infection and prosthesis loosening / 中华核医学与分子影像杂志

ABSTRACT

Objective:To explore the advantage of three-phase bone scintigraphy combined with SPECT/CT over three-phase bone scintigraphy in the differential diagnosis of periprosthetic infection from prosthesis loosening in patients after prosthesis replacement.Methods:Seventy patients (27 males, 43 females, age (69.5±10.5) years) who were suspected with prosthesis loosening or periprosthetic infection underwent 99Tc m-methylene diphosphonate (MDP) three-phase bone scintigraphy and SPECT/CT from October 2008 to November 2019 in Zhongshan Hospital, Fudan University were retrospectively reviewed. All patients had pathological diagnoses based on surgical resection or lesion biopsy. The diagnostic efficiency of three-phase bone scintigraphy images and three-phase bone scintigraphy combined with SPECT/CT were evaluated. χ2 test was used for data analysis. Results:Among 70 patients, 34(48.6%, 34/70) were diagnosed as periprosthetic infection and 36(51.4%, 36/70) were diagnosed as prosthesis loosening. Using three-phase bone scintigraphy for the differential diagnosis of bone lesions, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 94.1%(32/34), 77.8%(28/36), 85.7%(60/70), 80.0%(32/40) and 93.3%(28/30), when combined with SPECT/CT, the corresponding results were 94.1%(32/34), 94.4%(34/36), 94.3%(66/70), 94.1%(32/34), 94.4%(34/36), respectively. The specificity and accuracy were increased ( χ2 values: 4.167, 4.167, both P=0.031). Conclusion:Combination of three-phase bone scintigraphy with SPECT/CT can provide added value over three-phase bone scintigraphy for differential diagnosis in patients with periprosthetic loosening or periprosthetic infection.