Clinical note
Complications of shoulder arthroplasty: added value of SPECT/CT imaging
Complicaciones de las prótesis de hombro: valor añadido de la imagen SPECT/TC
J.P. Suárez
, M.L. Domínguez, N. Zeidán, M.E. García, D. Lisei, N. Martín, F.M. González
Corresponding author
Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Spain
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A) Imagen planar a las 24<span class="elsevierStyleHsp" style=""></span>horas en proyecciones anterior (izquierda) y posterior (derecha), que muestra varios depósitos patológicos (flechas) en el brazo y región axilar derechos. B) Estudio SPECT/TC a las 24<span class="elsevierStyleHsp" style=""></span>horas (cortes axiales TC, SPECT y fusión) que muestra depósitos patológicos (flechas) compatibles con proceso séptico en contacto con el componente humeral de la PTI derecha (fila superior), partes blandas superficiales del brazo derecho (fila media) y adenopatías axilares derechas (fila inferior).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.P. Suárez, M.L. Domínguez, N. Zeidán, M.E. García, D. Lisei, N. Martín, F.M. González" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.P." "apellidos" => "Suárez" ] 1 => array:2 [ "nombre" => "M.L." "apellidos" => "Domínguez" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Zeidán" ] 3 => array:2 [ "nombre" => "M.E." 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Suárez, M.L. Domínguez, N. Zeidán, M.E. García, D. Lisei, N. Martín, F.M. González" "autores" => array:7 [ 0 => array:4 [ "nombre" => "J.P." "apellidos" => "Suárez" "email" => array:1 [ 0 => "juanpablosuarez@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.L." "apellidos" => "Domínguez" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Zeidán" ] 3 => array:2 [ "nombre" => "M.E." "apellidos" => "García" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Lisei" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Martín" ] 6 => array:2 [ "nombre" => "F.M." "apellidos" => "González" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones de las prótesis de hombro: valor añadido de la imagen SPECT/TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 953 "Ancho" => 1200 "Tamanyo" => 119490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy of left RSA. (A) Delayed planar images in anterior (left) and posterior (right) projections showing an increased uptake in the left glenoid region (arrow), compatible with prosthetic loosening. A mild focal uptake is barely seen in the middle third of the left humerus (head arrow). (B) SPECT/CT images (from up to down: CT, SPECT and fusion images; from left to right: coronal, sagittal and axial views) are consistent with mechanical loosening of the glenoid component (arrows). (C) Details of coronal (left) and axial (right) views of the fusion SPECT/CT images, localizing the mild humeral uptake previously described on the medial side of the cortical bone of the left humeral diaphysis (arrows), far from the stem tip (head arrow), suggesting a stress lesion, and therefore discarding a loosening of the humeral prosthetic component.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Over the last two decades, the number of prosthetic shoulder replacements has increased notably, leading to a rising incidence of postsurgical complications and reoperations.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are several types of shoulder prostheses:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall">Partial shoulder arthroplasty (PSA) or hemiarthroplasty: Only a metallic humeral component is present (a humeral head, with or without a humeral stem).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">Total shoulder arthroplasty (TSA): Consists of a concave glenoid component, usually made of polyethylene, and another two humeral component pieces (a head and a stem, both made of metal).</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall">Reverse shoulder arthroplasty (RSA): This is the most frequently type implanted at the present. It features a convex metallic glenoid component (glenosphere), and two humeral component pieces (a concave ring of polyethylene and metal articulated with the glenosphere, and a metallic humeral stem).</p></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">Bone scintigraphy (BS) is a useful imaging technique to assess the failed prosthetic joint and provides additional information to conventional radiology (CR), computed tomography (CT) and magnetic resonance imaging (MRI), which are usually limited or artifacted by the metallic materials.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Furthermore, the introduction of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) imaging is leading to a more accurate diagnosis of prosthetic joint complications, mostly in hip and knee arthroplasties, especially because of its valuable anatomo-functional information.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The objective of the present study is to show the potential usefulness of SPECT/CT imaging in the diagnosis of complications of shoulder prostheses.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical cases</span><p id="par0040" class="elsevierStylePara elsevierViewall">We present 6 representative clinical cases of the most frequent complications of shoulder prostheses. All of the patients underwent a three-phase BS after the intravenous administration of 740 MBq <span class="elsevierStyleSup">99m</span>Tc-DPD, including the acquisition of immediate dynamic images of arterial perfusion, followed by soft-tissue perfusion images within the first 5<span class="elsevierStyleHsp" style=""></span>min. Three hours after the injection, static planar images were obtained in both anterior and posterior projections, and SPECT/CT imaging was subsequently performed in one of the two available hybrid tomographic systems, either a Symbia T2 series (Siemens) or a Discovery NM/CT 670 (General Electric Healthcare). The SPECT acquisition protocol was 60 frames (360°), 15–20<span class="elsevierStyleHsp" style=""></span>s/frame and a 128<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>128 matrix; and the CT imaging protocol was 120<span class="elsevierStyleHsp" style=""></span>kV, 80<span class="elsevierStyleHsp" style=""></span>mA, a slice thickness of 2.5<span class="elsevierStyleHsp" style=""></span>mm and a 512<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>512 matrix. Image reconstruction was performed with an OSEM 3D algorithm (2 iterations, 10 subsets), a preprocessing filter (Hann 0.9), a CT-based attenuation correction, and a postprocessing filter (Butterworth 10/0.48).</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical case 1</span><p id="par0045" class="elsevierStylePara elsevierViewall">An 85 year-old woman with a left RSA implanted 26 months before who presented severe pain at arm mobilization, and no clinical signs of infection. A doubtful radiolucence was seen around the superior screw in a radiography performed 1 year after surgery, although a CT scan 5 months later was normal. BS showed an increased uptake in the left glenoid area and mild focal uptake at the tip of the humeral stem, consistent with loosening of both prosthetic components. SPECT/CT images confirmed the loosening of the glenoid component and discarded any complication of the humeral stem (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient received a conservative treatment due to her high surgical risk, with good clinical outcome.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical case 2</span><p id="par0050" class="elsevierStylePara elsevierViewall">A 73 year-old man with a left RSA implanted 18 months before who was studied for shoulder pain and functional impairment, without any clinical signs of infection. CR detected a radiolucence area around the humeral cement and periarticular calcifications. BS showed a diffuse and heterogeneous increased uptake around the humeral stem, compatible with loosening. SPECT/CT images confirmed the humeral stem loosening and also detected an instability of the inferior screw of the glenoid component (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient underwent a total prosthesis replacement, with good clinical outcome.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Clinical case 3</span><p id="par0055" class="elsevierStylePara elsevierViewall">A 77 year-old man with a right TSA implanted 25 months before. He complained of pain in his right shoulder and functional impairment for a year. CR showed a questionable radiolucence around the humeral cement. BS detected a mild increased uptake in right glenoid region, without any signs of loosening of the humeral stem. SPECT/CT images were consistent with scapular notching (osteolysis of the scapular neck), that was later confirmed by a carefully review of the previous CR (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). A conservative treatment was performed, with satisfactory clinical evolution.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinical case 4</span><p id="par0060" class="elsevierStylePara elsevierViewall">A 59 year-old woman with a left PSA implanted 29 months before. She presented severe shoulder pain and functional impairment for the last 5 months, with no clinical signs of infection. The CR was normal, and both ultrasound and CT scans showed a narrowing of the glenohumeral joint. BS detected an increased uptake at the left glenoid region, and SPECT/CT images were compatible with a glenoid erosion (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The patient is currently being considered for a RSA implant.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Clinical case 5</span><p id="par0065" class="elsevierStylePara elsevierViewall">A 74 year-old man with a right RSA implanted 18 months before. He was being studied for active and passive shoulder pain and paresthesias in the cubital nerve territory. No infection was suspected and both CR and CT scans performed two months ago were normal. BS showed an increased in the posterior part of the right glenoid region, which corresponded in the SPECT/CT images to a displaced fracture in the posteroinferior edge of the glenoid cavity. This finding was confirmed by reviewing in detail the previous CT scan (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). A conservative treatment was firstly indicated, without any clinical improvement, so a surgical approach is actually being discussed.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinical case 6</span><p id="par0070" class="elsevierStylePara elsevierViewall">An 80 year-old woman with a right RSA implanted 4 years before. Two years after surgery, she presented a cellulitis in the medial side of the right arm with a purulent cutaneous fistula in the posterior side. An ultrasound scan also detected a subcutaneous collection in that area, but biopsies and microbiological cultures subsequently obtained were negative. Clinical evolution was torpid in spite of antibiotic treatment. A MRI scan performed 15 months later showed an altered signal in the posterior muscular compartment of the right arm, with no definite signs of infection. The patient underwent a shoulder CR six months later, with no abnormalities. She also underwent a three-phase BS that was compatible with humeral stem loosening. After this finding, a <span class="elsevierStyleSup">99m</span>Tc-HMPAO labelled white blood cell scintigraphy was performed, revealing several leucocyte-avid foci suspicious of a prosthetic and soft tissue septic processes. SPECT/CT confirmed the presence of periprosthetic infection, and besides, the septic involvement of soft tissues of the right arm and homolateral axillary lymph nodes (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). The infected prosthesis was removed and a cement spacer was implanted. The cultures of the prosthetic material were positive for <span class="elsevierStyleItalic">Corinebacterium striatum</span>. The patient received postsurgical antibiotic treatment, with normalization of inflammatory parameters, and nowadays she is waiting for a new RSA implantation.</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The most frequent complication of shoulder prostheses (approximately 21%) is the loosening of any of its components, with a higher incidence of the glenoid component respect to the humeral one (70% vs. 30%, respectively).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> The typical signs of prosthetic loosening in CR and CT are radiolucent lines around the metallic material, and the misalignment or displacement respect to its original position, although all of them have a low diagnostic accuracy.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Less frequent complications (<3%) include periprosthesic fractures, periprosthetic infections, or screw breaks of the glenoid component.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> However, the incidence of each type of complication depends on the type of implanted prosthesis. Thus, mechanical glenoid erosion or glenoiditis represents up to 20% of the PSA complications. On the other hand, the most frequent complication of RSA is the infraglenoid impingement or “scapular notching” (up to 70%), consisting in a mechanical osteolysis of the inferior portion of the scapular neck due to a collision with the medial edge of the polyethylene ring of the humeral component, which can evolve to a progressive exposition of the inferior screw and ultimately to a baseplate loosening.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The periprosthetic bone tissue reacts to complications with an increase of the osteogenic activity, that is easily detectable by BS and makes it a highly sensitive diagnostic technique in this setting. However, BS has several disadvantages, such as low specificity and high false positive results, especially because of its low spatial resolution and the lack of a precise anatomical localization of the findings.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> SPECT/CT imaging can overcome these limitations, and actually some promising preliminary results have been already reported in the evaluation of shoulder arthroplasties, although the number of cases published is significantly lower than other joint prostheses, such as hip or knee.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> On the other hand, CT images can provide additional information that may help to the interpretation of the SPECT images, for example, by detecting fracture lines or periarticular calcifications<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2,4–6</span></a>; even a 3D reconstruction of the fusion SPECT/CT images can be obtained in order to help the surgeon for planning a possible reoperation,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> although this topic must be the scope of future studies.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In this case series, SPECT/CT imaging was useful to confirm the BS findings, provided additional information and even detected non-suspected pathology, suggesting a potential role in the processes of diagnosis, decision-making and treatment of the complications of shoulder prostheses. However, more studies with larger number of patients are required to establish the diagnostic accuracy and the cost-effectiveness of this technique.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1214688" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1130586" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1214687" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1130585" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Clinical cases" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical case 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical case 2" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical case 3" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical case 4" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical case 5" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical case 6" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-11-02" "fechaAceptado" => "2018-12-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1130586" "palabras" => array:4 [ 0 => "Shoulder prosthesis" 1 => "SPECT/CT" 2 => "Bone scintigraphy" 3 => "Complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1130585" "palabras" => array:4 [ 0 => "Prótesis de hombro" 1 => "SPECT/TC" 2 => "Gammagrafía ósea" 3 => "Complicaciones" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of prosthetic shoulder replacements has increased considerably in recent years, as well as the complications derived from the procedure. The correct diagnosis of each type of complication is essential for therapeutic decision making, which is currently based on the information provided by radiological and nuclear medicine imaging. Nevertheless, both techniques have intrinsic limitations that could be mostly overcome with the advent of hybrid SPECT/CT imaging, which is set to play a fundamental role in the evaluation of shoulder prostheses.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El número de implantes protésicos de hombro se ha incrementado considerablemente en los últimos años, con el consiguiente aumento de las complicaciones derivadas de dicho procedimiento. El diagnóstico correcto de cada tipo de complicación es esencial para la toma de decisiones terapéuticas, y se basa actualmente en la información aportada tanto por las técnicas de radiodiagnóstico como de medicina nuclear. No obstante, ambos métodos diagnósticos presentan unas limitaciones intrínsecas que pueden ser superadas en gran medida con la incorporación de la imagen SPECT/TC, la cual está llamada a desempeñar un papel fundamental en la valoración de las prótesis de hombro.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Suárez JP, Domínguez ML, Zeidán N, García ME, Lisei D, Martín N, et al. Complicaciones de las prótesis de hombro: valor añadido de la imagen SPECT/TC. Rev Esp Med Nucl Imagen Mol. 2019;38:234–237.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 953 "Ancho" => 1200 "Tamanyo" => 119490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy of left RSA. (A) Delayed planar images in anterior (left) and posterior (right) projections showing an increased uptake in the left glenoid region (arrow), compatible with prosthetic loosening. A mild focal uptake is barely seen in the middle third of the left humerus (head arrow). (B) SPECT/CT images (from up to down: CT, SPECT and fusion images; from left to right: coronal, sagittal and axial views) are consistent with mechanical loosening of the glenoid component (arrows). (C) Details of coronal (left) and axial (right) views of the fusion SPECT/CT images, localizing the mild humeral uptake previously described on the medial side of the cortical bone of the left humeral diaphysis (arrows), far from the stem tip (head arrow), suggesting a stress lesion, and therefore discarding a loosening of the humeral prosthetic component.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 953 "Ancho" => 1200 "Tamanyo" => 120277 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy of left RSA. (A) Delayed planar images in anterior (left) and posterior (right) projections showing a diffuse and patchy increased uptake in the periphery of the humeral stem (arrows), compatible with loosening. A mild focus of increased uptake is also seen in the left glenoid region (head arrow). (B) SPECT/CT images (from top to bottom: CT, SPECT and fusion images; from left to right: coronal, sagittal and axial views) confirm the loosening of the humeral component (arrows). Furthermore, a mechanical instability of the inferior screw of the glenoid component (head arrow) is also detected. (C) Details of the CT coronal view (left) and fusion (right) of the glenoid component of the prosthesis, that clearly localizes the focal uptake next to the inferior screw.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 953 "Ancho" => 1200 "Tamanyo" => 136747 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy of right RSA. (A) Delayed planar images in anterior (left) and posterior (right) projections showing a mild focus of increased uptake in the right glenoid region (arrows). (B) SPECT/CT images (from top to bottom: CT, SPECT and fusion images; from left to right: coronal, sagittal and axial views) localize the previously described focus in the right scapular neck (arrows), compatible with scapular notching. Another focus of increased uptake is also seen next to the medial side of the humeral prosthetic ring, suggestive of mechanical bone stress due to the glenohumeral impingement (head arrows). (C) Radiological images confirm the osteolysis of the inferior region of neck scapula (arrow).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1200 "Ancho" => 1200 "Tamanyo" => 192384 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy of left PSA. (A) Delayed planar images in anterior (left) and posterior (right) projections showing a mild focus of increased uptake in the left glenoid region (arrows). (B) SPECT/CT images (from top to bottom: CT, SPECT and fusion images; from left to right: axial, sagittal and coronal views) localize the abnormal uptake in the subchondral bone of the left glenoid cavity (arrows), suggesting a glenoid erosion (glenoiditis).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1200 "Ancho" => 1200 "Tamanyo" => 190719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy of right RSA. (A) Delayed planar images in anterior (left) and posterior (right) projections showing a mild increased uptake in the right glenoid region (arrows). (B) SPECT/CT images (from top to bottom: CT, SPECT and fusion images; from left to right: axial, sagittal and coronal views) localize the pathological uptake in the posteroinferior edge of the right glenoid cavity (arrows), where a fracture line is detected by CT. (C) High resolution CT axial view confirms the displaced fracture (arrow).</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1200 "Ancho" => 1200 "Tamanyo" => 194821 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Radiolabelled white blood cell scintigraphy of right RSA. (A) Planar images in anterior (left) and posterior (right) projections at 24<span class="elsevierStyleHsp" style=""></span>h postinjection showing several foci of abnormal uptake in right arm and axilla region (arrows). (B) SPECT/CT images at 24<span class="elsevierStyleHsp" style=""></span>h (axial views of CT, SPECT and fusion images) confirm the septic process and localize the pathological uptake (arrows) in the humeral prosthetic component (superior), in the soft tissues of the right arm (middle) and in homolateral axillary lymphadenopathies (inferior).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SPECT/CT in postoperative shoulder pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Thélu-Vanysacker" 1 => "P. Frédéric" 2 => "T. Charles-Edouard" 3 => "B. Alban" 4 => "B. Nicolas" 5 => "B. Tanguy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.semnuclmed.2018.05.004" "Revista" => array:6 [ "tituloSerie" => "Semin Nucl Med" "fecha" => "2018" "volumen" => "48" "paginaInicial" => "469" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30193652" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuclear medicine and the failed joint replacement: past, present, and future" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.J. Palestro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4329/wjr.v6.i7.446" "Revista" => array:7 [ "tituloSerie" => "World J Radiol" "fecha" => "2014" "volumen" => "6" "paginaInicial" => "446" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25071885" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022347609000067" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of unconstrained shoulder prostheses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.F. Gonzalez" 1 => "G.B. Alami" 2 => "F. Baque" 3 => "G. Walch" 4 => "P. Boileau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jse.2010.11.017" "Revista" => array:6 [ "tituloSerie" => "J Shoulder Elbow Surg" "fecha" => "2011" "volumen" => "20" "paginaInicial" => "666" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21419661" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined single photon emission computerized tomography and conventional computerized tomography: clinical value for the shoulder surgeons?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.T. Hirschmann" 1 => "R. Schmid" 2 => "R. Dhawan" 3 => "J. Skarvan" 4 => "H. Rasch" 5 => "N.F. Friederich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0973-6042.86242" "Revista" => array:7 [ "tituloSerie" => "Int J Shoulder Surg" "fecha" => "2011" "volumen" => "5" "paginaInicial" => "72" "paginaFinal" => "76" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22058640" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022347617306455" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acromial and scapular spine fractures after reverse total shoulder arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I.P. Mayne" 1 => "S.N. Bell" 2 => "W. Wright" 3 => "J.A. Coghlan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1758573216628783" "Revista" => array:6 [ "tituloSerie" => "Shoulder Elbow" "fecha" => "2016" "volumen" => "8" "paginaInicial" => "90" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27583005" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atraumatic bilateral scapular spine fracture several months after bilateral reverse total shoulder arthroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Nicolay" 1 => "L. de Beuckeleer" 2 => "D. Stoffelen" 3 => "F. Vanhoenacker" 4 => "M. Pouillon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00256-013-1775-4" "Revista" => array:6 [ "tituloSerie" => "Skeletal Radiol" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "699" "paginaFinal" => "702" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24276680" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003800000004/v1_201907020628/S2253808919300114/v1_201907020628/en/main.assets" "Apartado" => array:4 [ "identificador" => "34046" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical note" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003800000004/v1_201907020628/S2253808919300114/v1_201907020628/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300114?idApp=UINPBA00004N" ]
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