18F-FDG PET for diagnosing painful arthroplasty/prosthetic joint infection

Abstract

Up to now, there were some studies about the role of 18F-FDG PET or PET/CT in the diagnosis of prosthetic joint infection after arthroplasty with different values of sensitivity and specificity. The purpose of this study was to systematically review the published data regarding the diagnostic performance of positron emission tomography (PET) or PET/computed tomography (PET/CT) in prosthetic infection after arthroplasty. A comprehensive computer literature search of studies published regarding PET or PET/CT in patients suspicious of prosthetic infection was performed. Pooled sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of PET or PET/CT in patients suspicious of prosthetic infection on a per prosthesis-based analysis were calculated. Sixteen studies comprising 1101 prosthesis with suspicious of prosthetic infection after arthroplasty were included in this meta-analysis. The pooled sensitivity of PET or PET/CT in detecting prosthetic infection was 87% [95% confidence interval (CI) 83–90%] on a per prosthesis-based analysis. The pooled specificity of PET or PET/CT in detecting prosthetic infection was 87% (95% CI 85–89%) on a per prosthesis-based analysis. The area under the ROC curve was 0.94 on a per prosthesis-based analysis. 18F-FDG PET or PET/CT demonstrated high sensitivity and specificity in subjects suspicious of prosthetic infection. However, various degrees of uptake in the asymptomatic patients are very common. Physicians should recognize these characteristics, and then 18F-FDG PET or PET/CT can act as an effective method in the diagnosis of prosthetic infection.