Stumpe Katrin D M, Nötzli Hubert P, Zanetti Marco, Kamel Ehab M, Hany Thomas F, Görres Gerhard W, von Schulthess Gustav K, Hodler Juerg
Department of Medical Radiology, Division of Nuclear Medicine, University Hospital, CH-8091 Zurich, Switzerland.
Radiology. 2004 May;231(2):333-41. doi: 10.1148/radiol.2312021596. Epub 2004 Mar 24.
To compare the diagnostic efficacy of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) with that of conventional radiography and three-phase bone scintigraphy in patients suspected of having infection in their total hip replacements.
Thirty-five patients with painful total hip replacements and possible septic prosthetic loosening were examined with FDG PET, conventional radiography, and three-phase bone scintigraphy. PET, radiographic, and scintigraphic images were each evaluated by two independent observers in a blinded fashion. For 32 of 35 patients, serial conventional radiographs were available. Results of microbiologic examinations of surgical specimens represented the standard of reference in 26 patients, and results of joint aspiration plus clinical follow-up of at least 6 months represented the standard of reference in the remaining nine patients. Sensitivity, specificity, accuracy, and interobserver variability (kappa) values were calculated. The imaging modalities were compared in terms of diagnostic confidence by using the sign test.
Nine patients had septic and 21 patients had aseptic loosening. In five patients, neither loosening nor infection was confirmed. For diagnosing infection with FDG PET, conventional radiography, and bone scintigraphy, respectively, sensitivity values for reader 1 and reader 2 were 33% and 22%, 89% and 78%, and 56% and 44%, while specificity values were 81% and 85%, 50% and 65%, and 88% and 92% and accuracy values were 69% for both readers, 60% and 69%, and 80% for both readers. PET was significantly more specific (P =.035) but less sensitive (P =.016) than conventional radiography for the diagnosis of infection.
In a study population of patients suspected of having infected total hip replacements, FDG PET performed similarly to three-phase bone scintigraphy. FDG PET was more specific but less sensitive than conventional radiography for the diagnosis of infection.
比较氟18氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）与传统X线摄影及三相骨闪烁显像对怀疑全髋关节置换感染患者的诊断效能。
对35例全髋关节置换疼痛且可能存在假体周围感染松动的患者进行FDG PET、传统X线摄影及三相骨闪烁显像检查。PET、X线及闪烁显像图像均由两名独立观察者以盲法进行评估。35例患者中的32例有系列传统X线片。26例患者手术标本的微生物学检查结果作为参考标准，其余9例患者关节穿刺结果加至少6个月的临床随访作为参考标准。计算敏感性、特异性、准确性及观察者间变异性（kappa）值。采用符号检验比较各成像方式的诊断可信度。
9例患者存在感染性松动，21例患者存在无菌性松动。5例患者既未证实有松动也未证实有感染。对于FDG PET、传统X线摄影及骨闪烁显像诊断感染，读者1和读者2的敏感性分别为33%和22%、89%和78%、56%和44%，特异性分别为81%和85%、50%和65%、88%和92%，准确性读者1和读者2均为69%、60%和69%、80%。PET在诊断感染方面比传统X线摄影特异性显著更高（P = 0.035）但敏感性更低（P = 0.016）。
在怀疑全髋关节置换感染的患者研究群体中，FDG PET与三相骨闪烁显像表现相似。FDG PET在诊断感染方面比传统X线摄影特异性更高但敏感性更低。
