Guidelines for Complications of Cancer Treatment Vol VIII Part B

its main role is confined to ruling out aseptic etiologies. Atechnetium-99m bone scan is sometimes performed for theinitial assessment of pain at the site of an arthroplasty and hasbeen reported to have a sensitivity of 33%, a specificity of86%, a positive predictive value of 30%, and a negativepredictive value of 88% for the detection of infection at thesite of a total joint replacement 37 . The indium-111-labeledleukocyte scan has a more promising role in the detection ofperiprosthetic infection, with a sensitivity of 77%, a specificityof 86%, a positive predictive value of 54%, and a negativepredictive value of 95% 38 . These two imaging modalities canbe combined to achieve greater results, and this has becomethe radionuclide imaging modality of choice for the diagnosisof periprosthetic infection 39 . The combined bone scan, despiteits relatively high accuracy, has a few drawbacks. It is a laborintensivetest that is often performed over two days as itrequires the handling of the patient’s white blood cells. Inaddition, the test involves numerous preparation steps and isprone to processing errors 39,41 .In recent years, a potential role of fluorodeoxyglucosepositronemission tomography (FDG-PET) scanning for thediagnosis of periprosthetic infection has been explored 39-41 .The test relies on the detection of inflammatory cells,particularly macrophages and neutrophils, with an increasedglucose uptake in areas of infection 34 . It has higher imagingresolution and easier and faster penetration ability into infectedtissues, and it can be performed within sixty minutes 40 . Someauthors have reported reliable results, with an accuracy rangingfrom 91% to 95%, when the FDG-PET scan has been comparedwith a triple-phase technetium bone scan 40,41 . However, inone study in which FDG-PET scanning was compared withcombined technetium-99m/indium-111-labeled leukocytescanning, FDG-PET scanning demonstrated poor accuracy,ranging from 47% to 71% 39 . In a more recent study 42 ,115