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I n t e r n a t i o n a l C o n f e r e n c e o n
Nuclear Medicine &
Radiation Therapy
Journal of Medical Physics and Applied Sciences
ISSN: 2574-285X
O c t o b e r 0 1 - 0 2 , 2 0 1 8
S t o c k h o l m , S w e d e n
Nuclear Medicine & Radiation Therapy 2018
Page 30
Biography
Christopher J Palestro has pioneered the use of combined
labelled leukocyte/bone marrow imaging for diagnosing os-
teomyelitis. He has authored or co-authored more than 150
peer reviewed articles, nearly 100 book chapters and review
articles. He serves on the Editorial Boards of Radiology,
Journal
of Nuclear Medicine and Quarterly Journal of Nuclear Medicine
and
Molecular Imaging
. He is Co-chair of the Society of Nucle-
ar Medicine and Molecular Imaging’s Working Group for the
Tc-99m and In-111 Labeled Leukocyte Procedure Standards/
Guidelines and Chair of the Appropriate Use Criteria Commit-
tee for Inflammation and Infection. He is a Former Chair of the
American Board of Nuclear Medicine. In 2013, he received the
Presidential Distinguished Educator Award from the Society of
Nuclear Medicine andMolecular Imaging. In 2017, he was elect-
ed as Fellow of the Society of Nuclear Medicine and Molecular
Imaging, one of that organization’s most prestigious awards.
palestro@northwell.eduLabelled leukocyte/bone marrow
imaging for diagnosing infection of
recently implanted lower extremity
arthroplasties
Christopher J Palestro
1
, C Love
2
, G G
Tronco
1
, K K Bhargava
1
and K J Nichols
1
1
Donald & Barbara Zucker School of Medicine, USA
2
Albert Einstein College of Medicine, USA
Christopher J Palestro et al., J. med phys & appl sci 2018, Volume: 3
DOI: 10.21767/2574-285X-C1-001
D
iagnosing lower extremity prosthetic joint infection during the first year after
implantation, when up to two thirds of these infections occur, is challenging.
Pain usually is present, fever is variable. Leucocytosis is a poor predictor of
infection. C-reactive protein remains elevated for up to three weeks. Erythrocyte
sedimentation rate can remain elevated for up to one year. Joint aspiration with
culture, the definitive preoperative diagnostic procedure, is specific, sensitivity is
variable. Plain radiographs lack sensitivity and specificity. Data on radionuclide
imagingduringtheearlypostoperativeperiodarelimited.Thebonescancanexclude
infection. It is a good rule out test, but cannot rule in infection.
67
Ga accumulates
in normally healing surgical incisions and in aseptic inflammation. With an overall
accuracy of 60%-80%, there is little role for this radiopharmaceutical in prosthetic
joint infection. Data about diagnosing prosthetic joint infection with
18
F-FDG in
the early post-operative period are scant; uptake of this radiopharmaceutical in a
variety of postoperative settings for variable time periods, however, is well known.
111
In labelled leukocytes do not accumulate in normally healing surgical wounds
and combined with bone marrow imaging is about 90% accurate for diagnosing
prosthetic joint infection. We reviewed combined labelled leukocyte/marrow
imaging performed on 40 lower extremity arthroplasties implanted within one year
before imaging, including 15 implanted within 3 months prior to imaging. Imaging
results were compared to final diagnoses, which were surgically, microbiologically
and histopathologically confirmed. 28/40 arthroplasties were infected including
10/15 imaged within three months after implantation. Sensitivity, specificity and
accuracy were 96%, 92%, 95% respectively for all 40 arthroplasties and 100%, 80%,
93% respectively for 15 arthroplasties imaged within 3 months after implantation.
Results are comparable to those reported for diagnosing prosthetic joint infection
in general and indicate that during the first year after implantation, when evolving
postoperative changes can confound diagnostic test results, labelled leukocyte/
marrow imaging accurately diagnoses lower extremity prosthetic joint infection.