Balanika A P, Papakonstantinou O, Kontopoulou C J, Baltas C S, Athanassia S, Kanelakopoulou K, Brountzos E, Gouliamos A, Kelekis N L
2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens, 12 464, Greece.
Skeletal Radiol. 2009 Apr;38(4):363-9. doi: 10.1007/s00256-008-0616-3. Epub 2008 Dec 10.
We aimed to carry out a systematic assessment of gray-scale and color Doppler ultrasonography (CDUS) findings of reactivated post-traumatic/postoperative chronic osteomyelitis (COM) in adults.
Gray-scale and color Doppler ultrasonography were performed on 40 consecutive patients with a history of long-standing post-traumatic/post-operative chronic osteomyelitis and clinical suggestion of reactivation, in a 32-month-period. All patients had metallic implants: 16 internal fixations, nine external fixations, 11 hip arthroplasties and four knee arthroplasties. The final diagnosis of reactivated COM was based upon biopsy findings, with microbiological and histological examination (n = 27), or a combination of laboratory, clinical and magnetic resonance (MR) findings (n = 13). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sonographic signs, including fistulous tracts, periosteal thickening, cortical discontinuity, soft tissue abscess and cellulitis, juxtacortical fluid, distension of the pseudocapsule in arthroplasties, and periosteal vascularity, were estimated.
Statistically significant differences between patients with and without reactivated COM were found for fistulous tracts (P < 0.0001), juxtacortical fluid collections (P < 0.001) periosteal thickening (P < 0.01), distension of pseudocapsule (P < 0.05), and periosteal vascularity (P < 0.0001). Low-resistance arterial flow of periosteal vessels presented the highest sensitivity (92%), specificity, and PPV (100%), yielding only two false negative results in two obese patients. Among gray-scale findings, the presence of a fistulous tract yielded the highest specificity and PPV (100%), whereas periosteal thickening was the most sensitive (92%), though not specific, finding (specificity 50%).
A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.
我们旨在对成人创伤后/术后慢性骨髓炎（COM）复发的灰阶及彩色多普勒超声（CDUS）表现进行系统评估。
在32个月的时间里，对40例有长期创伤后/术后慢性骨髓炎病史且有复发临床迹象的患者进行了灰阶及彩色多普勒超声检查。所有患者均有金属植入物：16例内固定、9例外固定、11例髋关节置换术和4例膝关节置换术。复发COM的最终诊断基于活检结果，包括微生物学和组织学检查（n = 27），或实验室、临床和磁共振（MR）检查结果的综合判断（n = 13）。评估了超声征象的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），这些征象包括瘘管、骨膜增厚、皮质连续性中断、软组织脓肿和蜂窝织炎、皮质旁液性暗区、关节置换术中假包膜扩张以及骨膜血管情况。
在有或无复发COM的患者之间，瘘管（P < 0.0001）、皮质旁液性暗区（P < 0.001）、骨膜增厚（P < 0.01）、假包膜扩张（P < 0.05）和骨膜血管情况（P < 0.0001）存在统计学显著差异。骨膜血管的低阻力动脉血流表现出最高的敏感性（92%）、特异性和PPV（100%），仅在两名肥胖患者中出现两个假阴性结果。在灰阶表现中，瘘管的存在具有最高的特异性和PPV（100%），而骨膜增厚是最敏感的（92%），但不具有特异性（特异性50%）。
一系列灰阶及CDUS表现可高度提示长期创伤后/术后慢性骨髓炎患者的骨感染复发。
