锝-99m 五价二巯基丁二酸与枸橼酸镓-67 成像对高度怀疑急性骨与关节感染患者的诊断效能比较

Koukouraki Sophia, Gaitanis Ioannis, Hatjipaulou Alexandros, Karkavitsas Nikolaos

Department of Nuclear Medicine, University Hospital Heraklion, Crete, Greece.

Hell J Nucl Med. 2006 May-Aug;9(2):99-102.

The purpose of this study was to evaluate and compare the diagnostic efficacy of (99m)Tc(V) dimercaptosuccinic acid ((99m)Tc(V)DMSA) with the (67)Ga-citrare ((67)Ga-C) scintigraphy in patients with suspected bone and joint infection. Thirty one patients, 19 men and 12 women, aged 18-78 y with median age 56 y, with suspected acute bone infection, were enrolled in this study. Besides (67)Ga-C and (99m)Tc(V)DMSA scintigraphy, all patients underwent X-ray radiography and technetium-99m methylene disphosphonate ((99m)Tc-MDP) bone scan for supporting the initial diagnosis. The (99m)Tc-MDP bone scan was considered positive for acute bone and joint infection when all its four scintigraphic phases were positive. Final diagnosis was based on needle aspiration and/or biopsy findings. Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) were calculated. Our results have shown the following: Seventeen patients (17/31) had histologically confirmed acute bone and joint infections, while the remaining patients had no infection. (99m)Tc(V)DMSA diagnosed bone and joint infections in all positive (17/31) patients while (67)Ga-C in 16/31 patients. Discordant scintigraphic results were observed by (67)Ga-C in 2/31 cases: in one positive case of femur postoperative infection (false negative for (67)Ga-C) and in one case of clinicaly suspected infection in the femur while the patient had a preexisting fracture (false positive with (67)Ga-C). No false negative results were observed with (99m)Tc(V)DMSA. Sensitivity, specificity, PPV, NPV and accuracy were maximum for (99m)Tc(V)DMSA, while for (67)Ga-C were: 94.1%, 93%, 94.1%, 93%, and 93.5% respectively. It is concluded that considering the high sensitivity and specificity of (99m)Tc(V)DMSA in the detection of acute bone and joint infections, the lower radiation dose, the cost and the shorter time spent for the imaging procedure, as compared to (67)Ga-C, (99m)Tc(V)DMSA should be preferred to (67)Ga-C as a bone scan agent for the detection of acute bone and joint infections.

本研究的目的是评估并比较锝（99m）锝（Ⅴ）二巯基丁二酸（（99m）Tc（Ⅴ）DMSA）与枸橼酸镓（67）（（67）Ga-C）闪烁扫描法对疑似骨与关节感染患者的诊断效能。31例年龄在18 - 78岁（中位年龄56岁）、疑似急性骨感染的患者纳入本研究，其中男性19例，女性12例。除了（67）Ga-C和（99m）Tc（Ⅴ）DMSA闪烁扫描法外，所有患者均接受了X线摄影和锝-99m亚甲基二膦酸盐（（99m）Tc-MDP）骨扫描以辅助初始诊断。当（99m）Tc-MDP骨扫描的所有四个闪烁相均为阳性时，则认为其对急性骨与关节感染呈阳性。最终诊断基于针吸活检和/或活检结果。计算了敏感性、特异性、准确性、阳性和阴性预测值（PPV和NPV）。我们的结果如下：17例患者（17/31）经组织学证实有急性骨与关节感染，其余患者无感染。（99m）Tc（Ⅴ）DMSA在所有阳性（17/31）患者中诊断出骨与关节感染，而（67）Ga-C在16/31例患者中诊断出感染。（67）Ga-C在2/31例中观察到闪烁扫描结果不一致：1例股骨术后感染阳性病例（（67）Ga-C假阴性），1例临床疑似股骨感染但患者有既往骨折史（（67）Ga-C假阳性）。（99m）Tc（Ⅴ）DMSA未观察到假阴性结果。（99m）Tc（Ⅴ）DMSA的敏感性、特异性、PPV、NPV和准确性最高，而（67）Ga-C的分别为：94.1%、93%、94.1%、93%和93.5%。结论是，考虑到（99m）Tc（Ⅴ）DMSA在检测急性骨与关节感染方面具有高敏感性和特异性，与（67）Ga-C相比辐射剂量更低、成本更低且成像程序耗时更短，（99m）Tc（Ⅴ）DMSA应优先于（67）Ga-C作为检测急性骨与关节感染的骨扫描剂。