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Z Orthop Ihre Grenzgeb 2003; 141(2): 153-159
DOI: 10.1055/s-2003-38649
Bildgebende Diagnostik
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Erste Erfahrungen mit der Fluorodeoxyglukose-Positronenemissionstomographie (FDG-PET) in der Diagnostik schmerzhafter Knie- und Hüfttotalendoprothesen

First Experiences with Fluorodeoxyglucose-Positron-Emission Tomography (FDG-PET) in the Evaluation of Painful Total Knee and Hip Joint ReplacementsK.  Kisielinski1 , U.  Cremerius2 , U.  Büll2 , B.  Hermanns3 , D.  C.  Wirtz1 , F.  U.  Niethard1
  • 1Orthopädische Universitätsklinik Aachen, Direktor: Univ.-Prof. Dr. med. F. U. Niethard
  • 2Nuklearmedizinische Universitätsklinik Aachen, Direktor: Univ.-Prof. Dr. med. U. Büll
  • 3Institut für Pathologie der Universitätsklinik Aachen, Direktor: Univ.-Prof. Dr. med. Ch. Mittermayer
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Publication History

Publication Date:
15 April 2003 (online)

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Zusammenfassung

Studienziel: Ziel war die Darstellung der ersten Erfahrungen mit der Positronenemissionstomographie und 18F-Fluorodeoxyglukose (FDG-PET) bei der Diagnostik schmerzhafter Endoprothesen. Methode: 12 Patienten mit revisionsbedürftigen Totalendoprothesen des Knies bzw. der Hüfte erhielten vor dem Eingriff eine PET. Zur Einordnung und Überprüfung des Verfahrens wurden die histopathologische, mikrobiologische als auch die intraoperative Diagnose mit den präoperativen PET-Befunden verglichen. Ergebnisse: Die Auswertung der intraoperativen Befunde, der mikrobiologischen Untersuchungen und der Histopathologien zeigte, dass neben den bekannten Determinanten Infekt und entzündlicher Gewebsreaktion infolge postoperativer Umbauvorgänge vor allem polyethylenabriebbedingte Fremdkörperreaktionen eine Rolle bei der Anreicherung spielen. Schlussfolgerung: Die FDG-PET eignet sich zur In-vivo-Darstellung ausgeprägter Gewebsreaktionen auf Polyethylenabrieb, welche eine aseptische Lockerung von Endoprothesen triggern. Hierdurch wird jedoch die Spezifität der PET-Diagnostik in der Detektion von Protheseninfekten eingeschränkt.

Summary

Aim: The aim of the study was to describe first experiences using FDG-PET in the examination of painful arthroplasties. Method: 12 patients prior to revision of a total hip or knee joint replacement underwent PET. Histopathology, microbiological analysis and intraoperative diagnosis were compared to preoperative PET findings. Results: The analysis of intraoperative findings, of microbiological examinations and of histopathology showed that besides the well known determinants infection and early postoperative granulation tissue, polyethylene wear induced foreign-body reaction was a major cause for increased FDG consumption. Conclusion: In vivo imaging of marked foreign-body tissue reaction induced by polyethylene wear is feasible by FDG-PET. This observation, however leads to reduced specifity of PET imaging for the diagnosis of periprosthetic infection.

Schlüsselwörter

FDG-PET - präoperative Diagnostik - Hüft-TEP - Knie-TEP - Polyethylenabrieb - aseptische Lockerung - Protheseninfekt

Key words

FDG-PET - total hip joint replacement - total knee joint replacement - aseptic loosening - arthroplasty infection

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Dr. med. K. Kisielinski

Orthopädische Universitätsklinik, Aachen

Pauwelsstraße 30

D-52057 Aachen

Email: kaikisielinski@yahoo.de

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