正电子发射断层扫描和单光子发射计算机断层扫描在骨髓炎和人工骨与关节感染中的应用：系统综述。

PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review.

机构信息

Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

出版信息

Semin Nucl Med. 2010 Jan;40(1):3-15. doi: 10.1053/j.semnuclmed.2009.08.005.

DOI:10.1053/j.semnuclmed.2009.08.005

PMID:19958846

Abstract

OBJECTIVE

To review the literature on diagnostic accuracy and clinical value of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) for imaging of bone and joint infections.

METHODS

The PubMed/MEDLINE and Embase (OvidSP) literature databases were systematically searched for publications on SPECT and PET on osteomyelitis and prosthetic bone and joint infections using specific guidelines with MeSH-terms, truncations, and completion using cross-references.

RESULTS

In 44 original articles (15 for SPECT and 29 for (18)F-fluorodeoxyglucose [FDG]-PET) on osteomyelitis and prosthetic bone and joint infection, 1634 patients were included (580 patients SPECT, 1054 patients FDG-PET). Level of evidence (Oxford criteria) was 2-3b. For SPECT, the highest diagnostic accuracy of 95% for diagnosis of bone and joint infections is achieved with combined (111)In-WBC and (99m)Tc-sulfur colloid. Acceptable diagnostic accuracy was also obtained with (99m)Tc-WBC or (111)In-WBC combined with (99m)Tc-methylene diphosphonate ((99m)Tc-MDP). FDG-PET is useful for diagnosis of osteomyelitis with a sensitivity and specificity generally over 95%. In patients with orthopedic implant infections, sensitivity varies widely from 28% to 91% and specificity from 9% to 97%. This variation in FDG-PET performance in orthopedic implant infections depends largely on the (use of different) criteria to diagnose infection. Determination of the best criteria is still a matter of debate.

CONCLUSIONS

SPECT/computed tomography (CT) with (111)In-WBC combined with (99m)Tc-MDP or (99m)Tc-sulfur colloid seems to be the best imaging technique for diagnosis of bone and joint infections. FDG-PET is also useful for diagnosis of osteomyelitis with improved spatial resolution over SPECT imaging, allowing more accurate localization. Localization can be further improved by adding CT. Diagnosis of orthopedic implant infections with FDG-PET depends strongly on the localization of the implant and the criteria used to diagnose infection. Confirmation of well defined criteria to diagnose infection on FDG-PET in patients with metallic implants is thus of paramount importance for optimal diagnosis.

摘要

目的

回顾单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET）在骨与关节感染影像学诊断中的准确性和临床价值的文献。

方法

根据特定的指南，使用 MeSH 术语、截短词和交叉参考进行系统搜索，在 PubMed/MEDLINE 和 Embase（OvidSP）文献数据库中搜索有关骨髓炎和人工关节感染的 SPECT 和 PET 出版物。

结果

在关于骨髓炎和人工关节感染的 44 篇原始文章（15 篇关于 SPECT，29 篇关于（18）F-氟脱氧葡萄糖[FDG]-PET）中，共纳入 1634 例患者（580 例 SPECT，1054 例 FDG-PET）。证据水平（牛津标准）为 2-3b。对于 SPECT，诊断骨与关节感染的最高准确性为 95%，可通过联合（111）In-WBC 和（99m）Tc-硫胶体实现。（99m）Tc-WBC 或（111）In-WBC 与（99m）Tc-亚甲基二膦酸盐（（99m）Tc-MDP）联合也可获得可接受的诊断准确性。FDG-PET 对骨髓炎的诊断有用，其敏感性和特异性通常超过 95%。在骨科植入物感染患者中，敏感性从 28%到 91%不等，特异性从 9%到 97%不等。FDG-PET 在骨科植入物感染中的性能差异主要取决于用于诊断感染的（不同的）标准。确定最佳标准仍然是一个有争议的问题。

结论

（111）In-WBC 联合（99m）Tc-MDP 或（99m）Tc-硫胶体的 SPECT/计算机断层扫描（CT）似乎是诊断骨与关节感染的最佳影像学技术。FDG-PET 对骨髓炎的诊断也很有用，与 SPECT 成像相比，空间分辨率得到改善，允许更准确的定位。通过添加 CT 可以进一步改善定位。FDG-PET 诊断骨科植入物感染强烈依赖于植入物的定位和用于诊断感染的标准。因此，对于优化诊断，在有金属植入物的患者中使用 FDG-PET 确定明确的感染诊断标准非常重要。