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Open AccessArticle

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

1
Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy
2
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands
*
Author to whom correspondence should be addressed.
Authors contributed equally.
J. Clin. Med. 2020, 9(12), 4031; https://doi.org/10.3390/jcm9124031
Received: 18 November 2020 / Revised: 9 December 2020 / Accepted: 11 December 2020 / Published: 13 December 2020
(This article belongs to the Section Nuclear Medicine & Radiology)
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 [99mTc]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. View Full-Text
Keywords: WBC scintigraphy; qualitative analysis; semi-quantitative analysis; BMS WBC scintigraphy; qualitative analysis; semi-quantitative analysis; BMS
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MDPI and ACS Style

Lauri, C.; Lauretti, G.; Galli, F.; Campagna, G.; Tetti, S.; Riolo, D.; Signore, A. Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections. J. Clin. Med. 2020, 9, 4031. https://doi.org/10.3390/jcm9124031

AMA Style

Lauri C, Lauretti G, Galli F, Campagna G, Tetti S, Riolo D, Signore A. Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections. Journal of Clinical Medicine. 2020; 9(12):4031. https://doi.org/10.3390/jcm9124031

Chicago/Turabian Style

Lauri, Chiara; Lauretti, Giancarlo; Galli, Filippo; Campagna, Giuseppe; Tetti, Simone; Riolo, Donatella; Signore, Alberto. 2020. "Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections" J. Clin. Med. 9, no. 12: 4031. https://doi.org/10.3390/jcm9124031

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