Diagnostic Performance of Single-Photon Emission Computed Tomography/Computed Tomography in Aseptic Loosening: A Systematic Review and Meta-Analysis

Background: The aim of this study is to evaluate the diagnostic value and clinical applicability of single photon emission computed tomography/computed tomography (SPECT/CT) in aseptic loosening (AL) of prostheses by meta-analysis. Method: Literature on the diagnostic value of SPECT/CT in AL of prostheses was obtained by computer and manual review. The quality of the included studies was evaluated according to the Quality Assessment Diagnostic Accuracy Studies 2. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and other indicators were calculated, and a forest map and summary receiver operating characteristic were drawn to calculate the area under the curve. Meta regression analysis was performed to identify the sources of heterogeneity and corresponding subgroup analysis was performed. A Fagan plot, likelihood ratio point plot, and Deek's funnel plot were drawn and analyzed. Results: A total of 15 studies were included. The meta-analysis results showed that the pooled sensitivity and specificity of SPECT/CT for the diagnosis of aseptic prosthetic loosening were 0.94, 95% confidence interval [CI] (0.90-0.96) and 0.89, 95% CI (0.78-0.95), respectively while the pooled positive likelihood ratio and pooled negative likelihood ratio were 8.65, 95% CI (4.18-17.90) and 0.07, 95% CI (0.04-0.11), respectively. The pooled diagnostic odds ratio was 130.36, 95% CI (45.18-376.19), and the area under the curve was 0.97, 95% CI (0.95-0.98). Conclusion: As a diagnostic method for AL, SPECT/CT has high diagnostic sensitivity and specificity as well as high diagnostic efficiency. It has good clinical application value and should be a primary choice in the diagnosis of AL after joint replacement. (c) 2021 Published by Elsevier Inc.