三相骨显像联合SPECT/CT鉴别假体周围感染与假体松动的增益价值  

Added value of three-phase bone scintigraphy combined with SPECT/CT for differential diagnosis of periprosthetic infection and prosthesis loosening

作　　者：朱静 谭辉 石洪成 Zhu Jing;Tan Hui;Shi Hongcheng(Shanghai Institute of Medical Imaging Department of Nuclear Medicine,Zhongshan Hospital,Fudan University Nuclear Medicine Institute of Fudan University Cancer Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海市影像医学研究所、复旦大学附属中山医院核医学科、复旦大学核医学研究所、复旦中山医院肿瘤中心,200032

出　　处：《中华核医学与分子影像杂志》2021年第9期531-535,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：上海市临床重点专科项目(shslczdzk03401)。

摘　　要：目的探讨三相骨显像联合SPECT/CT较三相骨显像鉴别假体周围感染与假体松动的增益价值。方法回顾性分析2008年10月至2019年11月行关节置换术后临床疑似假体周围感染与假体松动于复旦大学附属中山医院核医学科行三相骨显像联合SPECT/CT的70例患者[男27例、女43例,年龄(69.5±10.5)岁]的临床和影像学资料,以术中所见或穿刺活组织病理检查诊断为标准,评价三相骨显像及三相骨显像联合SPECT/CT在假体周围感染与假体松动中的诊断价值。采用χ2检验分析数据。结果70例患者中,确诊假体周围感染34例(48.6%,34/70),假体松动36例(51.4%,36/70)。三相骨显像诊断假体周围感染的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为94.1%(32/34)、77.8%(28/36)、85.7%(60/70)、80.0%(32/40)和93.3%(28/30);联合SPECT/CT后的诊断效能分别为94.1%(32/34)、94.4%(34/36)、94.3%(66/70)、94.1%(32/34)、94.4%(34/36);特异性及准确性有明显提高(χ2值:4.167和4.167,均P=0.031)。结论三相骨显像联合SPECT/CT对假体周围感染与假体松动的诊断具有增益价值。Objective To explore the advantage of three-phase bone scintigraphy combined with SPECT/CT over three-phase bone scintigraphy in the differential diagnosis of periprosthetic infection from prosthesis loosening in patients after prosthesis replacement.Methods Seventy patients(27 males,43 females,age(69.5±10.5)years)who were suspected with prosthesis loosening or periprosthetic infection underwent 99Tcm-methylene diphosphonate(MDP)three-phase bone scintigraphy and SPECT/CT from October 2008 to November 2019 in Zhongshan Hospital,Fudan University were retrospectively reviewed.All patients had pathological diagnoses based on surgical resection or lesion biopsy.The diagnostic efficiency of three-phase bone scintigraphy images and three-phase bone scintigraphy combined with SPECT/CT were evaluated.χ2 test was used for data analysis.Results Among 70 patients,34(48.6%,34/70)were diagnosed as periprosthetic infection and 36(51.4%,36/70)were diagnosed as prosthesis loosening.Using three-phase bone scintigraphy for the differential diagnosis of bone lesions,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 94.1%(32/34),77.8%(28/36),85.7%(60/70),80.0%(32/40)and 93.3%(28/30),when combined with SPECT/CT,the corresponding results were 94.1%(32/34),94.4%(34/36),94.3%(66/70),94.1%(32/34),94.4%(34/36),respectively.The specificity and accuracy were increased(χ2 values:4.167,4.167,both P=0.031).Conclusion Combination of three-phase bone scintigraphy with SPECT/CT can provide added value over three-phase bone scintigraphy for differential diagnosis in patients with periprosthetic loosening or periprosthetic infection.

关 键 词：关节成形术 置换 髋 假体相关感染 假体失效 放射性核素显像 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 99M锝美罗酸盐 

分 类 号：R817.4[医药卫生—影像医学与核医学] R687.4[医药卫生—放射医学]