Nuclear Medicine in Prosthetic Complications: Current Situation with SPECT and PET

Abstract

Our aim is to review the literature on single-photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging used in the diagnosis of bone and joint prosthesis complications, as well as information based on our clinical experience. Literature databases were systematically searched for SPECT and PET publications on prosthetic complications, especially bone and joint prosthesis infections. Combined radiolabeled leukocyte and Technetium-99m (Tc-99m) sulfur colloid studies used in SPECT imaging are still stated as the gold standard non-invasive method, which maintains the highest diagnostic accuracy of 96% in the diagnosis of bone and joint infections. Radioactively labeled leukocyte SPECT obtained with combined Tc-99m methylene diphosphonate also provides acceptable diagnostic accuracy. These combined methods have limitations such as being time consuming and requiring sensitive laboratory process. Fluor-18 fluorodeoxyglucose (F-18 FDG) PET imaging is also useful for the diagnosis of bone and joint prosthesis infections, providing better spatial resolution and more accurate localization than SPECT imaging, and with a sensitivity and specificity generally above 83%. The diagnostic performance of FDG-PET in orthopedic implant infections may vary, and this largely depends on the diagnostic criteria of the infection. Verification of well-defined criteria for the indication of infection with FDG-PET in patients with metal implants is very important for optimal diagnosis. In a recent clinical study using the metal artifact reduction method, it was shown that this method has a positive effect on the quantitative accuracy of metal prostheses in PET/CT and increases the reliability of image interpretation. The use of SPECT and PET methods in combination with CT provides accurate anatomical localization with high-resolution images and increases diagnostic accuracy. With the results obtained from new studies conducted in this field, the expectation that the existing diagnostic methods will be replaced by superior alternatives in the future is promising. © Telif Hakkı 2022 Türkiye Nükleer Tıp Derneği