三时相骨显像诊断人工关节假体周围感染  

Three phase bone scintigraphy in diagnosis of periprosthetic artificial joint infection

作　　者：李原[1] 李虎[2] 王茜[1] 崔浩然 王白成 LI Yuan;LI Hu;WANG Qian;CUI Haoran;WANG Baicheng(Department of Nuclear Medicine,Peking University People’s Hospital,Beijing 100044,China;Arthritis Clinic and Research Center,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院核医学科,北京100044 [2]北京大学人民医院关节病诊疗研究中心,北京100044

出　　处：《中国医学影像技术》2020年第10期1527-1532,共6页Chinese Journal of Medical Imaging Technology

摘　　要：目的评价三时相骨显像(TPBS)对人工关节置换术(AJR)后假体周围感染(PJI)的诊断价值。方法回顾性分析236例(324个关节)AJR后患者的TPBS资料,包括PJI组120个关节(48髋,72膝)、无菌性松动组119个关节(75髋,44膝)及对照组85个关节(28髋,57膝)。以视觉和半定量法分析假体周围显像剂摄取;依据最终临床诊断评价不同视觉判断标准诊断PJI的价值;以半定量分析比较各组间血池相摄取差异,得到最佳诊断阈值,评价其诊断效能。结果以血流、血池显像发现异常摄取诊断髋关节感染的准确率高于膝关节(92.68%vs 65.51%,P<0.001)。半定量分析显示,PJI组髋关节靶/本底比值(TBR)高于无菌性松动组和对照组(P均<0.001),无菌性松动组与对照组间差异无统计学意义(P>0.05);PJI组膝关节TBR高于无菌性松动组和对照组(P均<0.001),无菌性松动组高于对照组(P<0.001)。以TBR≥1.44为阈值,诊断膝关节感染的准确率为91.38%。结论TPBS可用于诊断PJI;对髋关节假体感染通过视觉判断即可获得较高准确率,对膝关节假体感染则应结合半定量分析进行判断。Objective To explore the value of three phase bone scintigraphy(TPBS)in diagnosis of periprosthetic joint infection(PJI)after artificial joint replacement(AJR).Methods TPBS data of 236 patients with 324 joints after AJR were retrospectively analyzed,including 120 joints(48 hips,72 knees)in PJI group,119 joints(75 hips,44 knees)in aseptic loosening group and 85 joints(28 hips,57 knees)in control group.The uptake of imaging agent around prosthesis was analyzed with visual and semi-quantitative methods.The diagnostic values of different visual judgment criteria for PJI were evaluated according to final clinical diagnosis,and blood pool phases were compared among different groups with semi-quantitative analysis to obtain the best diagnostic threshold and evaluate the diagnostic efficiency.Results The accuracy rate of abnormal uptake in diagnosis of hip joint infection was higher than that of knee joint infection(92.68%vs 65.51%,P<0.001).Semi-quantitative analysis showed that the target to background ratio(TBR)of hip joint in PJI group was higher than that in aseptic loosening group and control group(both P<0.001),while there was no significant difference between aseptic loosening group and control group(P>0.05).TBR of knee joint in PJI group was higher than that in aseptic loosening group and control group(both P<0.001),and in aseptic loosening group was higher than in control group(P<0.001).Taken TBR≥1.44 as the threshold,the diagnostic accuracy for PJI of knee joint was 91.38%.Conclusion TPBS could be used to diagnose PJI after AJR.The visual judgment of TPBS had high accuracy in diagnosis of hip prosthesis infection,whereas combining with semi-quantitative analysis was necessary for judging knee prosthesis infection.

关 键 词：关节成形术 置换 放射性核素显像 人工关节周围感染 

分 类 号：R684[医药卫生—骨科学] R817.4[医药卫生—外科学]