SPECT/CT结合三相骨显像诊断假体周围感染的价值分析  

Value of SPECT/CT Combined with Three-phase Bone Imaging in the Diagnosis of Periprosthetic Infection

作　　者：李占银[1] 阿尖措[1] 苏桂芳[2] LI Zhan-yin;E Jian-cuo;SU Gui-fang(Department of Orthopaedics,Qinghai Red Cross Hospital,Xining 81100,Qinghai Province,China;不详)

机构地区：[1]青海红十字医院骨二科,青海西宁810001 [2]青海红十字医院妇科,青海西宁810001

出　　处：《中国CT和MRI杂志》2019年第12期139-142,共4页Chinese Journal of CT and MRI

基　　金：青海省自然科技攻关基金资助项目(201349082)

摘　　要：目的分析单光子发射计算机断层成像术/计算机断层成像(SPECT/CT)结合三相骨显像诊断假体周围感染的价值。方法以2015年1月-2018年10月于我院行人工关节置换术,术后出现疼痛、活动障碍表现,经手术确诊为为假体松动或假体周围感染的84例患者为研究对象展开回顾性分析。于显像前1周内行实验室检查,检测血清超敏C反应蛋白(hs-CRP)及红细胞沉降率(ESR)水平,并行SPECT/CT结合三相骨显像检查,获得SPECT血流相、血池相、延迟相、SPECT断层图像、CT断层图像及SPECT/CT融合图像。将实验室检查及SPECT/CT结合三相骨显像检查结果与手术确诊结果对照,比较二者鉴别诊断假体周围感染的诊断效能。结果84例患者,经假体翻修术确诊为假体周围感染者52例,假体松动32例;实验室检查诊断假体周围感染的Kappa值为0.224,一致性较差;SPECT/CT结合三相骨显像诊断假体周围感染的Kappa值为0.796,一致性较好;SPECT/CT结合三相骨显像诊断假体周围感染的敏感性、特异性及准确性均显著高于实验室检查诊断,差异有统计学意义(χ^2=7.648,9.621,16.460,P均<0.05)。结论较之于常规实验室检查,SPECT/CT结合三相骨显像诊断效能更高,更接近手术确诊结果,可作为临床鉴别诊断假体周围感染的有效方法。Objective To analyze the value of single photon emission computed tomography/computed tomography(SPECT/CT)combined with three-phase bone imaging in the diagnosis of periprosthetic infection.Methods 84 patients with pain and activity disorder after surgery undergoing artificial joint replacement in the hospital who were surgically diagnosed as prosthetic loosening or periprosthetic infection from January 2015 to October 2018 were retrospectively analyzed.Laboratory examinations were performed within 1 week before imaging.The levels of serum high-sensitivity C-reactive protein(hs-CRP)and erythrocyte sedimentation rate(ESR)were detected.SPECT/CT combined with three-phase bone imaging was performed to obtain SPECT blood flow phase,blood pool phase,delayed phase,SPECT tomographic image,CT tomographic image and SPECT/CT fusion image.The results of laboratory examination and SPECT/CT combined with three-phase bone imaging examination were compared with the results of surgical diagnosis as control.The diagnostic efficiency by the two methods for differential diagnosis of periprosthetic infection was compared.Results Of the 84 patients,there were 52 patients with periprosthetic infection and 32 patients with prosthetic loosening diagnosed by prosthetic revision.The Kappa value of periprosthetic infection by laboratory examination was 0.224.And the consistency was poor.The Kappa value for the diagnosis of periprosthetic infection by SPECT/CT combined with three-phase bone imaging was 0.796.And the consistency was good.The sensitivity,specificity and accuracy by SPECT/CT combined with three-phase bone imaging for the diagnosis of periprosthetic infection were significantly higher than laboratory examination(χ^2=7.648,9.621,16.460,all P<0.05).Conclusion Compared with routine laboratory examination,the diagnostic efficiency is higher by SPECT/CT combined with three-phase bone imaging,which is closer to the diagnosis result of surgery.It can be used as an effective method for clinical differential diagnosis of periprosthetic

关 键 词：SPECT/CT融合图像 三相骨显像 假体周围感染 诊断价值 

分 类 号：R619.3[医药卫生—外科学] R681.2[医药卫生—临床医学]