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High protracted (99m)Tc-HDP uptake in synthetic bone implants - a potentially misleading incidental finding on bone scintigraphy

Mainta, Ismini
Amzalag, Gaël
Paycha, Frédéric
Published in Knee. 2014, vol. 21, no. 6, p. 1284-1287
Abstract We report the case of a 56-year-old male with bilateral total knee prostheses suffering from bilateral knee pain mainly on the right side and referred for bone scintigraphy. The medical history of the patient revealed an opening wedge high tibial osteotomy performed nine years earlier, with insertion of two blocks of ceramic made of hydroxyapatite and tricalcium phosphate in a wedge configuration as synthetic bone substitutes. The porous structure of these implants is analogous to the architecture of cancellous bone and permits fibrovascular and bone ingrowth, promoting the healing process. Planar scintigraphy and SPECT/CT showed an intense uptake within those implants in the early phase as well as in the late phase of the bone scan. It also showed bilateral patellofemoral arthritis. A (99m)Tc-labeled antigranulocyte antibody scintigraphy was negative for infection or inflammation. Bilateral patellar resurfacing led to complete symptom regression, confirmed at 10 months follow-up. To the best of our knowledge, this scintigraphic pattern with such a high tracer uptake reflecting bone substitute osteointegration has not yet been published. This should be considered in patients with such bone replacement materials that are increasingly used, in order to avoid false diagnosis of inflammation or infection.
Keywords Arthroplasty, Replacement, KneeCeramics/chemistryHumansHydroxyapatites/chemistryKnee Joint/surgeryKnee ProsthesisMaleMiddle AgedOsteomyelitis/radionuclide imagingPatellofemoral Pain Syndrome/etiology/radionuclide imagingRadiopharmaceuticals/diagnostic useTechnetium Tc 99m Medronate/analogs & derivatives/diagnostic useTomography, Emission-Computed, Single-PhotonTomography, X-Ray Computed/methods
PMID: 25224667
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Research groups Groupe Ratib Osman (nouvelles techniques d'imagerie moléculaire) (819)
Imagerie per-opératoire multi-modalité en radiologie interventionnelle (949)
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TABOURET VIAUD, Claire et al. High protracted (99m)Tc-HDP uptake in synthetic bone implants - a potentially misleading incidental finding on bone scintigraphy. In: Knee, 2014, vol. 21, n° 6, p. 1284-1287. doi: 10.1016/j.knee.2014.08.005 https://archive-ouverte.unige.ch/unige:78456

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Deposited on : 2015-12-09

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