^(18)F-FDG PET/CT对创伤后骨髓炎的诊断价值  

^(18)F-FDG PET/CT in the Diagnosis of Post-Traumatic Osteomyelitis

作　　者：杨芳 张毓艺 冯瑾 张连娜 高璇 陈紫薇 YANG Fang;ZHANG Yuyi;FENG Jin;ZHANG Lianna;GAO Xuan;CHEN Ziwei(Department of Nuclear Medicine,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院核医学科,北京100035

出　　处：《中国医学影像学杂志》2024年第12期1266-1271,共6页Chinese Journal of Medical Imaging

基　　金：北京积水潭医院院级科研基金项目(QN-202115)。

摘　　要：目的 探讨^(18)F-FDG PET/CT在创伤后骨髓炎中的代谢影像特征,并评估其诊断准确性。资料与方法 回顾性分析2019年5月—2020年4月于北京积水潭医院行^(18)F-FDG PET/CT检查的创伤后骨折愈合不良可疑感染患者64例,采用定性及半定量评估方法评价^(18)F-FDG PET/CT对创伤后骨髓炎的诊断准确性,并与实验室指标血沉、C反应蛋白及白细胞计数的诊断效能进行比较,采用Logistic回归分析具有诊断意义的参数。结果 64例患者中,37例确诊为创伤后骨髓炎,其中23例通过术中微生物培养阳性确诊,14例通过临床症状及随访结果确诊。其余27例患者中,10例术中微生物培养、17例临床随访6个月以上均未提示感染。^(18)F-FDG PET/CT正确诊断37例感染组中的34例,正确排除27例感染阴性组中的23例,诊断敏感度、特异度、阳性预测值、阴性预测值及总体诊断准确度分别为91.89%、85.19%、89.47%、88.46%和89.06%。感染组中^(18)F-FDG PET/CT半定量指标最大标准化摄取值(SUVmax)为6.23±2.16,感染阴性组为4.24±1.86,差异有统计学意义(t=3.864,P<0.01)。Logistic回归分析显示,SUVmax和C反应蛋白为具有诊断意义的参数,且SUVmax诊断准确度高于C反应蛋白(χ^(2)=27.245,P<0.001)。结论^(18)F-FDG PET/CT显像提供的代谢影像特征有助于为诊断创伤后骨髓炎提供更精准的参考依据,值得临床推广应用。Purpose To investigate the ^(18)F-FDG PET/CT metabolic characteristics and the accuracy of diagnosis in post-traumatic osteomyelitis.Materials and Methods A total of 64 patients with post-traumatic fracture nonunion and suspected infection in Beijing Jishuitan Hospital were retrospectively analyzed.The PET/CT examinations were performed from May 2019 to April 2020.Qualitative and semi-quantitative evaluation methods were used to evaluate the diagnostic accuracy of ^(18)F-FDG PET/CT in post-traumatic osteomyelitis.The diagnostic efficiency was compared among different laboratory indexes,such as erythrocyte sedimentation rate,C-reactive protein and leukocyte.Logistic regression was used to analyze parameters with diagnostic significance.Results Among 64 patients with post-traumatic fracture nonunion,37 were ultimately diagnosed with post-traumatic osteomyelitis.Among them,23 were confirmed through positive microbial cultures during surgery,and 14 were diagnosed based on clinical symptoms and follow-up results.The remaining 27 patients showed no signs of infection based on intraoperative microbial cultures(n=10)or clinical follow-up of more than six months(n=17).PET/CT correctly identified infections in 34 of the 37 infected cases and accurately ruled out infections in 23 of the 27 non-infected cases.The sensitivity,specificity,positive predictive value,negative predictive value and overall diagnostic accuracy of PET/CT were 91.89%,85.19%,89.47%,88.46%and 89.06%,respectively.The maximum standardized uptake value(SUVmax)of PET/CT semi-quantitative parameter in the infection group(6.23±2.16)was higher than that in the non-infection group(4.24±1.86),showing a statistically significant difference(t=3.864,P<0.01).Logistic regression analysis revealed that SUVmax and C-reactive protein had diagnostic significance for distinguishing between groups,and SUVmax demonstrated higher diagnostic accuracy than C-reactive protein(χ^(2)=27.245,P<0.001).Conclusion The metabolic imaging features provided by ^(18)F-FDG PET/CT imagin

关 键 词：骨髓炎 创伤和损伤 正电子发射断层摄影术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 感染 

分 类 号：R445.5[医药卫生—影像医学与核医学] R619.3[医药卫生—诊断学]