The value of 99mTc-MDP bone SPECT/CT in evaluation of patients with painful knee prosthesis.

Abstract

OBJECTIVE:

The purpose of this study was to assess the incremental value of technetium-99m-methyl diphosphonate (Tc-MDP) single-photon emission computed tomography/computed tomography (SPECT/CT) over Tc-MDP two-phase bone scan (TPBS) in the assessment of the patients with pain following knee arthroplasty.

PATIENTS AND METHODS:

Tc-MDP TPBS and Tc-MDP SPECT/CT were performed in 49 patients with knee pain after knee arthroplasty. The scans were reviewed by two readers (nuclear medicine physician and musculoskeletal radiologist). Tc-MDP SPECT/CT studies were interpreted in conjunction with TPBS in this retrospective study to identify the pain generator in painful knee prosthesis. The final diagnosis was established based on a combination of histopathological/cytological findings, other imaging findings (e.g. MRI, radiolabelled white scan), clinical decisions, and management outcomes (including subsequent intraoperative findings).

RESULTS:

In diagnosing infection or aseptic loosening, a definitive outcome regarding the presence/absence of aseptic loosening or periprosthetic infection was obtained in 41 patients. (a) Sensitivity of Tc-MDP SPECT/CT [100%; 95% confidence interval (CI): 66.4-100%] was higher than Tc-MDP TPBS (88.9%; 95% CI: 51.8-99.7%). (b) Specificity of Tc-MDP SPECT/CT (75%; 95% CI: 53.3-90.2%) was considerably higher than Tc-MDP TPBS (30%; 95% CI: 11.9-54.3%). Alternative diagnoses were identified in 21/49 (43%) patients on Tc-MDP SPECT/CT, which could not be ascertained on Tc-MDP TPBS alone.

CONCLUSION:

Tc-MDP SPECT/CT has better sensitivity and specificity compared with Tc-MDP TPBS in diagnosis of aseptic loosening and periprosthestic infection in patients with painful knee arthroplasty. Tc-MDP SPECT/CT identified alternative causes of pain in 43% of patients, which was not identified by Tc-MDP TPBS.

• Authors: Ramin Mandegaran, Kanhaiyalal Agrawal, Sanjay Vijayanathan, Gopinath Gnanasegaran
• Journal: Nuclear medicine communications (Nucl Med Commun) Vol. 39 Issue 5 Pg. 397-404 (May 2018) ISSN: 1473-5628 [Electronic] England
• PMID: 29553970 (Publication Type: Journal Article)

Chemical References

• Technetium Tc 99m Medronate

Topics

• Adult
• Aged
• Arthroplasty, Replacement, Knee (adverse effects)
• Female
• Humans
• Knee Prosthesis (adverse effects)
• Male
• Pain (diagnostic imaging, etiology)
• Retrospective Studies
• Single Photon Emission Computed Tomography Computed Tomography
• Technetium Tc 99m Medronate