Zhang Rufan, Feng Zihao, Zhang Yong, Tan Hui, Wang Jian, Qi Fazhi
Department of Plastic and Reconstructive Surgery, Zhong-shan Hospital, 180 Fenglin Road, Xuhui District, Shanghai, China.
Department of Nuclear Medicine, Zhong-shan Hospital, 180 Fenglin Road, Xuhui District, Shanghai, China.
J Plast Reconstr Aesthet Surg. 2018 Dec;71(12):1768-1776. doi: 10.1016/j.bjps.2018.07.017. Epub 2018 Aug 2.
Deep sternal wound infection (DSWI) is a refractory complication after heart surgery, and debridement is the first-line treatment. The accurate identification of the extent of the infection is the key to successful debridement. The present study assessed the diagnostic accuracy of fluorine-18 deoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) for identifying the infected area of DSWI.
Between February 2015 and May 2017, 73 consecutive patients with suspected DSWI received F-FDG PET/CT examinations before their operation. The PET/CT and extracted CT images were analyzed by nuclear medicine physicians and radiologists to determine whether the sternum, mediastinum, vascular prosthesis, and each costal cartilage were infected. All the patients received debridement and chest wall reconstruction within 1 week following the PET scan. The final diagnosis was on the basis of surgical, microbiological, and histopathological findings.
Of the 73 patients, 64, 54, 28, and 6 patients were diagnosed with sternal osteomyelitis, mediastinitis, costal chondritis, and vascular graft infection (VGI), respectively. The sensitivities of PET/CT for diagnosing sternal osteomyelitis, mediastinitis, and costal chondritis were 98.4%, 77.8%, and 100.0%, respectively, and the corresponding specificities were 94.7%, 82.1%, and 100.0%, respectively. PET/CT correctly diagnosed all six cases of VGI. There were 65 infected costal cartilages in the patients with costal chondritis. The sensitivity, specificity, and accuracy of PET/CT for locating infected costal cartilages were 81.5%, 99.8%, and 98.6%, respectively.
PET/CT proved to be a useful tool for determining the depth of DSWI and for locating infected costal cartilage; therefore, this tool can help guide debridement.
深部胸骨伤口感染（DSWI）是心脏手术后一种难治性并发症，清创术是一线治疗方法。准确识别感染范围是清创术成功的关键。本研究评估了氟 - 18脱氧葡萄糖（F - FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）对识别DSWI感染区域的诊断准确性。
2015年2月至2017年5月期间，73例连续疑似DSWI的患者在手术前接受了F - FDG PET/CT检查。核医学医师和放射科医生分析PET/CT和提取的CT图像，以确定胸骨、纵隔、血管假体和每根肋软骨是否感染。所有患者在PET扫描后1周内接受清创术和胸壁重建。最终诊断基于手术、微生物学和组织病理学检查结果。
73例患者中，分别有64例、54例、28例和6例被诊断为胸骨骨髓炎、纵隔炎、肋软骨炎和血管移植物感染（VGI）。PET/CT诊断胸骨骨髓炎、纵隔炎和肋软骨炎的敏感性分别为98.4%、77.8%和100.0%，相应的特异性分别为94.7%、82.1%和100.0%。PET/CT正确诊断了所有6例VGI。肋软骨炎患者中有65根肋软骨感染。PET/CT定位感染肋软骨的敏感性、特异性和准确性分别为81.5%、99.8%和98.6%。
PET/CT被证明是确定DSWI深度和定位感染肋软骨的有用工具；因此，该工具有助于指导清创术。
