Department of infectious and tropical diseases, hôpital Pellegrin, CHU de Bordeaux, 33076 Bordeaux, France; Centre de référence infections ostéo-articulaires complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France.
Centre de référence infections ostéo-articulaires complexes du Grand Sud-Ouest (Crioac GSO), 33076 Bordeaux, France; Service de médecine nucléaire, hôpital Pellegrin, 33076 Bordeaux, France; INCIA, UMR, CNRS 5287, université de Bordeaux, 33076 Bordeaux, France.
Joint Bone Spine. 2019 Jul;86(4):503-508. doi: 10.1016/j.jbspin.2019.01.009. Epub 2019 Jan 31.
Post-operative instrumented spine infection (PISI) is an infrequent complication. Diagnosis of spinal implant infection can be difficult, especially in case of chronic infection.
This retrospective study attempts to evaluate the diagnostic performance of [F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in PISI. Imagings were performed between April 2010 and June 2018 among patients referred for suspected chronic spinal implant infection. PET/CT were performed more than 12 weeks after surgery. PET/CT images were re-interpreted independently by two nuclear medicine physicians without knowledge of the patient's conditions. PET/CT data were analyzed both visually and semi-quantitatively (SUV). MRI results were collected from medical records. The final diagnosis of infection was based on bacteriological cultures or a twelve-month follow-up.
Forty-nine PET/CT were performed in 44 patients (22 women, median age 65.0 years). Twenty-two patients had a diagnosis of infection during follow-up. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PET/CT were 86.4%, 81.5%, 79.2%, and 88.0%. Sensitivity, specificity, PPV and NPV were 66.7%, 75.0%, 66.0%, 75.0% respectively for MRI and 50.0%, 92.6%, 84.6% and 69.4% for serum C-reactive protein (CRP). Although these values were higher for PET/CT than for MRI or CRP, the differences were not statistically significant. In this setting, false positives with PET/CT can be observed in case of previous spine infection or adjacent segments disc disease. False negatives can result of extensive instrumented arthrodesis or infection with low virulence bacteria.
PET/CT is useful for the diagnosis of PISI. These results should be evaluated in further prospective study.
术后有植入物的脊柱感染（PISI）是一种罕见的并发症。脊柱植入物感染的诊断可能具有挑战性，尤其是在慢性感染的情况下。
本回顾性研究试图评估氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）在 PISI 中的诊断性能。对 2010 年 4 月至 2018 年 6 月间因疑似慢性脊柱植入物感染而就诊的患者进行了成像检查。在手术后 12 周以上进行了 PET/CT。两位核医学医师独立对 PET/CT 图像进行重新解读，而不了解患者的病情。对 PET/CT 数据进行了视觉和半定量（SUV）分析。MRI 结果从病历中收集。感染的最终诊断基于细菌培养或 12 个月的随访。
44 例患者共进行了 49 次 PET/CT（22 例女性，中位年龄 65.0 岁）。22 例患者在随访期间被诊断为感染。PET/CT 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 86.4%、81.5%、79.2%和 88.0%。MRI 的敏感性、特异性、PPV 和 NPV 分别为 66.7%、75.0%、66.0%和 75.0%，而血清 C 反应蛋白（CRP）的敏感性、特异性、PPV 和 NPV 分别为 50.0%、92.6%、84.6%和 69.4%。尽管与 MRI 或 CRP 相比，PET/CT 的这些值更高，但差异无统计学意义。在这种情况下，先前的脊柱感染或相邻节段椎间盘疾病可能会导致 PET/CT 出现假阳性。广泛的器械性融合或感染低毒力细菌可能导致假阴性。
PET/CT 对 PISI 的诊断有用。这些结果应在进一步的前瞻性研究中进行评估。
