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Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections

Despite the application of EANM recommendations for radiolabelled white-blood-cells (WBC) scintigraphy, some cases still remain doubtful based only on visual analysis. The aim of this study was to investigate the role of semi-quantitative analysis and bone marrow scan (BMS) in solving doubtful cases...

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Autores principales: Lauri, Chiara, Lauretti, Giancarlo, Galli, Filippo, Campagna, Giuseppe, Tetti, Simone, Riolo, Donatella, Signore, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763501/
https://www.ncbi.nlm.nih.gov/pubmed/33322146
http://dx.doi.org/10.3390/jcm9124031
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author Lauri, Chiara
Lauretti, Giancarlo
Galli, Filippo
Campagna, Giuseppe
Tetti, Simone
Riolo, Donatella
Signore, Alberto
author_facet Lauri, Chiara
Lauretti, Giancarlo
Galli, Filippo
Campagna, Giuseppe
Tetti, Simone
Riolo, Donatella
Signore, Alberto
author_sort Lauri, Chiara
collection PubMed
description Despite the application of EANM recommendations for radiolabelled white-blood-cells (WBC) scintigraphy, some cases still remain doubtful based only on visual analysis. The aim of this study was to investigate the role of semi-quantitative analysis and bone marrow scan (BMS) in solving doubtful cases. We retrospectively evaluated all [(99m)Tc]HMPAO-WBC scintigraphies performed, in the last 7 years, for a suspected monolateral prosthetic joint infection (PJI). In doubtful cases, we used five different thresholds of increase of target-to-background (T/B) ratio, between delayed and late images, as criteria of positivity (5%, 10%, 15%, 20% and 30%). BMS were also analysed and sensitivity, specificity and accuracy of different methods were calculated according to final diagnosis. The sensitivity, specificity and accuracy were, respectively, 77.8%, 43.8% and 53.0% for the cut-off at 5%; 72.2%, 66.7% and 68.2% for the cut-off at 10%; 66.7%, 75.0% and 72.7% for the cut-off at 15%; 66.7%, 85.4% and 80.3% for the cut-off at 20%; 33.3%, 93.8% and 77.3% for the cut-off at 30%. BMS provided a significantly higher diagnostic performance than 5%, 10% and 15% thresholds. Conversely, we did not observe any statistically significant difference between BMS and the cut-off of more than 20%. Therefore, doubtful cases should be analysed semi-quantitatively. An increase in T/B ratio of more than 20% between delayed and late images, should be considered as a criterion of positivity, thus avoiding BMS.
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spelling pubmed-77635012020-12-27 Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections Lauri, Chiara Lauretti, Giancarlo Galli, Filippo Campagna, Giuseppe Tetti, Simone Riolo, Donatella Signore, Alberto J Clin Med Article Despite the application of EANM recommendations for radiolabelled white-blood-cells (WBC) scintigraphy, some cases still remain doubtful based only on visual analysis. The aim of this study was to investigate the role of semi-quantitative analysis and bone marrow scan (BMS) in solving doubtful cases. We retrospectively evaluated all [(99m)Tc]HMPAO-WBC scintigraphies performed, in the last 7 years, for a suspected monolateral prosthetic joint infection (PJI). In doubtful cases, we used five different thresholds of increase of target-to-background (T/B) ratio, between delayed and late images, as criteria of positivity (5%, 10%, 15%, 20% and 30%). BMS were also analysed and sensitivity, specificity and accuracy of different methods were calculated according to final diagnosis. The sensitivity, specificity and accuracy were, respectively, 77.8%, 43.8% and 53.0% for the cut-off at 5%; 72.2%, 66.7% and 68.2% for the cut-off at 10%; 66.7%, 75.0% and 72.7% for the cut-off at 15%; 66.7%, 85.4% and 80.3% for the cut-off at 20%; 33.3%, 93.8% and 77.3% for the cut-off at 30%. BMS provided a significantly higher diagnostic performance than 5%, 10% and 15% thresholds. Conversely, we did not observe any statistically significant difference between BMS and the cut-off of more than 20%. Therefore, doubtful cases should be analysed semi-quantitatively. An increase in T/B ratio of more than 20% between delayed and late images, should be considered as a criterion of positivity, thus avoiding BMS. MDPI 2020-12-13 /pmc/articles/PMC7763501/ /pubmed/33322146 http://dx.doi.org/10.3390/jcm9124031 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lauri, Chiara
Lauretti, Giancarlo
Galli, Filippo
Campagna, Giuseppe
Tetti, Simone
Riolo, Donatella
Signore, Alberto
Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections
title Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections
title_full Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections
title_fullStr Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections
title_full_unstemmed Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections
title_short Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections
title_sort handling of doubtful wbc scintigraphies in patients with suspected prosthetic joint infections
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763501/
https://www.ncbi.nlm.nih.gov/pubmed/33322146
http://dx.doi.org/10.3390/jcm9124031
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