Muhammet AŞIK, Mustafa YILDIRIM, Ahmet Semih DOĞAN, Melih Engin ERKAN

Protez Enfeksiyonlarında Nükleer Tıp Yöntemleri

Protezi bulunan hastalarda aseptik gevşeme ile enfeksiyonu ayırt etmek önemlidir çünkütedavileri çok farklıdır. Bu iki antiteyi birbirinden ayırmanın bazı güçlükleri vardır. Periferikkanda artmış lökosit, eritrosit sedimantasyon hızı ve C reaktif protein seviyeleri enfeksiyon içinne sensitif ne de spesifiktir. Eklem aspirasyonu ile yapılan gram boyama ve kültür %90’ınüzerinde spesifiteye sahip olsa da sensitivitesi %28-%92 arasında seyreder. Bilgisayarlıtomografi ve manyetik rezonans görüntüleme yöntemlerinin kullanımı ise metalik artefaktsebebiyle sınırlıdır. Radyonüklid görüntüleme yöntemleri ise ortopedik metalik artefaktlardanetkilenmezler ve şüpheli eklem protezi enfeksiyonu olgularında günümüzde kullanılırlar. Kemiksintigrafisi problemli eklem protezini tespit etmede sensitif bir yöntemdir fakat kesin tanıyıkoymada başarısızdır. Bu yüzden kemik sintigrafisi tarama testi olarak veya diğer radyonüklidçalışmalarla kombine kullanılır. Kombine galyum/kemik sintigrafisi tek başına kemiksintigrafisine göre hafif düzeyde tanıya olumlu katkı yapmıştır. Günümüzde yaklaşık %90doğruluğa sahip olan işaretli beyaz küre/kemik iliği sintigrafisinin kombine kullanımı eklemprotezi enfeksiyonu tanısında tercih edilen radyonüklid görüntüleme yöntemidir. 18Fflorodeoksiglukoz pozitron emisyon tomografisi üzerinde araştırmalar devam etmektedir, eklemprotezi enfeksiyonlarındaki yeri henüz tartışmalıdır

Anahtar Kelimeler:

Eklem Protezi, Enfeksiyon, Nükleer Tıp

Nuclear Medicine In Prosthesis Infections

Differentiating aseptic loosening from infection in patients with prosthesis is important becausetheir treatments are very different. Differentiating these two entities have some difficulties.Increased peripheral blood leukocytes, erythrocyte sedimentation rate, and C-reactive proteinlevels are neither sensitive nor specific for infection. Although joint aspiration with Gram stainand culture has a specificity of 90% or more, its sensitivity ranges from 28% to 92%. Computedtomography and magnetic resonance imaging modalities are limited by hardware-inducedartifacts. Radionuclide imaging is not affected by orthopedic hardware and is the current imagingmodality of choice for suspected joint replacement infection. Bone scintigraphy is sensitive foridentifying the failed joint replacement, however, can not be used to determine the definitediagnose. Thus, bone scintigraphy is used as a screening test or combined with other radionuclidestudies. Combined bone and gallium imaging mildly improve the diagnose over bonescintigraphy alone. Presently, combined leukocyte/marrow imaging, with approximately 90%accuracy, is the radionuclide imaging procedure of choice for diagnosing prosthetic jointinfection. 18F-fluorodeoxyglucose positron emission tomography has been investigated. Itsvalue in the diagnosis of prosthetic joint infection is debatable

Keywords:

Joint Prosthesis, Infection, Nuclear Medicine,

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