Wang Guo-lin, Zhao Kui, Liu Zhen-feng, Dong Meng-jie, Yang Shu-ye
PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, People's Republic of China.
Nucl Med Commun. 2011 Dec;32(12):1134-42. doi: 10.1097/MNM.0b013e32834b455c.
Functional nuclear medicine imaging techniques have become particularly important in the diagnosis of osteomyelitis. The aim of our study was to perform a meta-analysis to obtain a reliable estimate of the diagnostic performance of fluorodeoxyglucose-positron emission tomography (FDG-PET), three-phase bone scintigraphy, leukocyte scintigraphy, and monoclonal antigranulocyte antibody (MOAB) scintigraphy in the assessment of suspected osteomyelitis and to perform pairwise comparisons of the diagnostic accuracy between these different imaging modalities.
A total of 23 studies representing 851 examinations that were published from January 1980 to October 2010 were reviewed. These studies evaluated the role of FDG-PET, three-phase bone scintigraphy, leukocyte scintigraphy, and MOAB scintigraphy in the assessment of suspected osteomyelitis. Systematic methods were used to identify, select, and evaluate the methodological quality of the studies and to summarize the overall findings of sensitivity and specificity. Two-sample Z-tests were conducted to evaluate for differences in sensitivity, specificity, area under the curve (AUC), and the Q* index between any two diagnostic modalities.
The FDG-PET had a pooled sensitivity of 0.923, specificity of 0.920, and AUC of 0.9666, whereas for bone scintigraphy, the corresponding values were 0.827, 0.446, and 0.6514, respectively, for leukocyte scintigraphy, the corresponding values were 0.742, 0.881, and 0.9139, respectively, and for MOAB, the corresponding values were 0.883, 0.705, and 0.8897, respectively. Our meta-analysis did not find statistically significant differences in the sensitivity, specificity, AUC, and Q* index between FDG-PET and leukocyte scintigraphy.
Leukocyte scintigraphy can be used with satisfactory diagnostic accuracy for detecting osteomyelitis when positron emission tomography systems are not available. The FDG-PET appears to be superior in terms of accuracy compared with other radionuclide imaging modalities.
功能核医学成像技术在骨髓炎的诊断中已变得尤为重要。我们研究的目的是进行一项荟萃分析，以可靠地评估氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）、三相骨闪烁显像、白细胞闪烁显像和单克隆抗粒细胞抗体（MOAB）闪烁显像在疑似骨髓炎评估中的诊断性能，并对这些不同成像方式之间的诊断准确性进行两两比较。
回顾了1980年1月至2010年10月发表的共23项研究，代表851次检查。这些研究评估了FDG-PET、三相骨闪烁显像、白细胞闪烁显像和MOAB闪烁显像在疑似骨髓炎评估中的作用。采用系统方法识别、选择和评估研究的方法学质量，并总结敏感性和特异性的总体结果。进行双样本Z检验以评估任意两种诊断方式之间在敏感性、特异性、曲线下面积（AUC）和Q*指数方面的差异。
FDG-PET的合并敏感性为0.923，特异性为0.920，AUC为0.9666；而骨闪烁显像的相应值分别为0.827、0.446和0.6514；白细胞闪烁显像的相应值分别为0.742、0.881和0.9139；MOAB的相应值分别为0.883、0.705和0.8897。我们的荟萃分析未发现FDG-PET与白细胞闪烁显像在敏感性、特异性、AUC和Q*指数方面存在统计学显著差异。
在没有正电子发射断层扫描系统时，白细胞闪烁显像可用于检测骨髓炎，诊断准确性令人满意。与其他放射性核素成像方式相比，FDG-PET在准确性方面似乎更具优势。
