Quantitative periprosthetic PET/CT

定量假体周围 PET/CT

• 批准号: 7685275
• 负责人: THOMAS F LANG
• 金额: $ 13.86万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-05 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7685275
• 关键词: Affect; Algorithms; Arthroplasty; Clinical; Complication; Data; Degenerative polyarthritis; Detection; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic radiologic examination; Differential Diagnosis; Discipline of Nuclear Medicine; Disease; Early Diagnosis; Enrollment; Ensure; Equipment; Failure; Foundations; Goals; Gold; Growth; Hip region structure; Image; Imaging Phantoms; Implant; Infection; Infiltration; Inflammatory; Inflammatory Response; Institution; Joints; Knee; Knee Prosthesis; Laboratories; Lead; Lesion; Location; Longevity; Lytic Metastatic Lesion; Measurement; Measures; Metals; Minority; Morbidity - disease rate; Morphologic artifacts; Operative Surgical Procedures; Osteolysis; Outcome; Pain; Participant; Patients; Pilot Projects; Positron-Emission Tomography; Process; Prosthesis; Replacement Arthroplasty; Research; Scanning; Science; Sensitivity and Specificity; Solid; Source; Specificity; Surgical Management; Techniques; Testing; Thick; Time; Tissues; Tracer; Translating; United States; Work; X-Ray Computed Tomography; arthropathies; attenuation; base; bone; clinical care; design; early onset; follow-up; improved; in vivo; innovation; knee replacement arthroplasty; mortality; multimodality; novel; patient safety; premature; prevent; public health relevance; septic; simulation; success; tool; transmission process; uptake; usability

DESCRIPTION (provided by applicant): Of the approximately 350,000 total joint replacements that are currently performed in the U.S. each year, a significant number will require premature revision operation. One of the most challenging diagnostic aspects of the painful implant is the differentiation between aseptic osteolysis, an inflammatory response to infiltration of wear debris, and infection of the tissue surrounding the joint. Current diagnostic techniques such as plain radiography, laboratory and nuclear medicine tests have severe shortcomings. At the same time, failed diagnosis of infection can dramatically worsen the outcome of a revision operation with sharply increased morbidity and mortality, and underestimation of the extent of aseptic osteolysis may lead to wrong timing of the revision. Both Computed Tomography (CT) and Positron Emission Tomography (PET) have been recognized as potential diagnostic alternatives with excellent sensitivity and specificity for both conditions. However, CT suffers from severe image artifacts in the presence of metallic implants that not only render the CT images undiagnostic but also negatively influence the usability of PET data when they are obtained with modern multimodality PET/CT equipment. In a pilot study at our institution on a dedicated imaging phantom, algorithmic reduction of CT metal artifact was shown to be effective for CT-based diagnosis of aseptic osteolysis. The main objective of the proposed research is to extend this work to PET/CT and thereby create a novel one-stop diagnostic tool for both aseptic osteolysis and infection. The experimental focus of this proposal is to build an osteolysis and infection phantom simulator to optimize and test our metal artifact reduction algorithms, and to test the hypothesis that a combination PET/CT scan is more useful than standalone PET in a small study of 20 patients with painful hip or knee prostheses. Furthermore, based on follow-up CT imaging we will for the first time be able to assess progression rates of aseptic osteolysis directly next to the implant. We believe that a novel metal artifact-corrected PET/CT scan will ensure patient safety by providing a differential diagnosis of both aseptic osteolysis and infection and will help improve surgical planning and avoid misdiagnosis of osteolysis and infection with its painful and costly consequences. PUBLIC HEALTH RELEVANCE: Joint replacement with artificial hips and knees has become a very successful surgical choice to treat osteoarthritis and other joint diseases. Because of the large number of patients so treated, the small fraction of implants that develop painful loosening results in a large rate of patients needing to undergo revision surgery. It is important to correctly diagnose the complication causing the pain to ensure optimal patient management and surgical planning. We propose to overcome the technical challenges associated with using X-ray computed tomography for imaging of metallic implants and use the technique in combination with Positron Emission Tomography to provide a novel comprehensive tool for the early diagnosis of the complications that would otherwise lead to implant failure.

描述（由申请人提供）：在美国目前在美国目前执行的大约350,000个联合置换量中，大量数量将需要过早的修订操作。疼痛植入物最具挑战性的诊断方面之一是无菌性骨溶解，对磨损碎屑浸润的炎症反应以及关节周围组织的感染。当前的诊断技术，例如普通射线照相，实验室和核医学测试，存在严重的缺点。同时，失败的感染诊断可能会大大恶化修订手术的结果，而发病率和死亡率急剧增加，并且低估了无菌骨溶解的程度可能会导致修订的错误时机。计算机断层扫描（CT）和正电子发射断层扫描（PET）都被认为是潜在的诊断替代方案，对这两种情况都具有出色的敏感性和特异性。但是，在存在金属植入物的情况下，CT遭受了严重的图像伪像，这些植入物不仅会使CT图像未诊断，而且在使用现代多峰性PET/CT设备获得的PET数据时会对它们产生负面影响。在我们机构对专用成像幻影的一项试点研究中，CT金属伪像的算法还原可有效地基于CT的无菌性骨溶解。拟议的研究的主要目的是将这项工作扩展到PET/CT，从而为无菌骨溶解和感染创建一种新型的一站式诊断工具。该提案的实验重点是建立彻底溶解和感染模拟器，以优化和测试我们的金属伪像还原算法，并检验以下假设：在20名具有痛苦的髋关节或膝盖伪造的患者的小型研究中，组合PET/CT扫描比独立PET更有用。此外，基于随访CT成像，我们将首次能够直接在植入物旁边评估无菌骨溶解的进展速率。我们认为，通过提供对无菌性骨溶解和感染的鉴别诊断，一种新型的金属伪像校正的PET/CT扫描将确保患者的安全性，并将有助于改善手术计划，并避免因其痛苦和昂贵的后果而造成骨溶解和感染的误诊。公共卫生相关性：人造臀部和膝盖的关节替代已成为治疗骨关节炎和其他关节疾病的非常成功的手术选择。由于受到大量治疗的患者，植入物的一小部分会导致疼痛松动，从而导致需要进行翻修手术的大量患者。正确诊断并发症，导致疼痛确保最佳患者管理和手术计划很重要。我们建议克服与使用X射线计算机断层扫描对金属植入物进行成像相关的技术挑战，并将技术与正电子发射断层扫描结合使用，为早期诊断并发症提供新颖的综合工具，这些工具否则会导致植入物衰竭。