Department of Nuclear Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
Department of Nuclear Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany.
BMJ Mil Health. 2021 Feb;167(1):8-17. doi: 10.1136/jramc-2019-001172. Epub 2019 Feb 20.
Combat-related extremity injuries are regularly associated with long-term complications such as chronic infection, especially osteomyelitis. Clinical examination and laboratory parameters do not usually allow reliable diagnosis. In contrast, imaging techniques enable constructive assertions to be made about the location and extent of an infection of the peripheral musculoskeletal system. The aim of this study was therefore to determine the diagnostic reliability of three-phase bone scanning and antigranulocyte scintigraphy using Tc-99m-sulesomab (Leukoscan) in the diagnostic clarification of infections associated with combat-related extremity injuries.
Twenty-seven male patients (mean age 33.9 years) with suspected combat-associated infections of the extremities were included in this retrospective analysis. All patients underwent three-phase bone scanning using Tc-99m-HDP followed by antigranulocyte scintigraphy with Tc-99m-sulesomab. In 26 of the 27 patients, a CT scan of affected limb was obtained, where the secondary fusion with single photon emission CT data set was possible. The diagnostic reliability of imaging techniques was validated against microbiological samples obtained during surgery and used as gold standard.
Three-phase bone scanning yielded a positive result in all patients, with 18 scans classified as true positive (TP) and nine scans as false positive (FP). This produced a sensitivity of 100%, a specificity of 0% and a positive predictive value (PPV) of 67%. Antigranulocyte scintigraphy recognised 13 patients as TP, 1 patient as FP, 8 patients as true negative (TN) and 5 patients as false negative (FN), which gave a sensitivity of 72%, a specificity of 88%, a PPV of 93%, a negative predictive value (NPV) of 62% and an accuracy of 78%. CT recognised in 7 cases a TP result, in 3 cases an FP, in 5 cases a TN and in 11 cases an FN result. This produced a sensitivity of 39%, a specificity of 63%, a PPV of 70%, an NPV of 31% and an accuracy of 46%.
Three-phase bone scanning did not deliver any diagnostic benefit, since no result was able to differentiate unequivocally between infection-related and reactive changes. Antigranulocyte scintigraphy using Tc-99m-sulesomab represented a highly suitable technique for diagnostically clarifying combat-related infections of the extremities. It is superior to CT in sensitivity, specificity, PPV, NPV and accuracy.
与战斗相关的四肢损伤常伴有长期并发症，如慢性感染，尤其是骨髓炎。临床检查和实验室参数通常无法进行可靠的诊断。相比之下，影像学技术可对周围肌肉骨骼系统感染的位置和范围进行建设性的断言。因此，本研究的目的是确定使用 Tc-99m-sulesomab（Leukoscan）进行三相骨扫描和抗粒细胞闪烁显像在诊断与战斗相关的四肢损伤相关感染中的诊断可靠性。
本回顾性分析纳入了 27 名男性患者（平均年龄 33.9 岁），这些患者均怀疑患有与战斗相关的四肢感染。所有患者均接受 Tc-99m-HDP 三相骨扫描，然后进行 Tc-99m-sulesomab 抗粒细胞闪烁显像。在 27 名患者中的 26 名患者中，获得了受累肢体的 CT 扫描，其中可以与单光子发射 CT 数据集进行二次融合。将影像技术的诊断可靠性与手术中获得的微生物样本进行验证，并作为金标准。
三相骨扫描在所有患者中均呈阳性结果，其中 18 次扫描被归类为真阳性（TP），9 次扫描为假阳性（FP）。这产生了 100%的敏感性、0%的特异性和 67%的阳性预测值（PPV）。抗粒细胞闪烁显像将 13 名患者识别为 TP，1 名患者为 FP，8 名患者为真阴性（TN），5 名患者为假阴性（FN），其敏感性为 72%，特异性为 88%，PPV 为 93%，阴性预测值（NPV）为 62%，准确性为 78%。CT 在 7 例中识别出 TP 结果，在 3 例中识别出 FP 结果，在 5 例中识别出 TN 结果，在 11 例中识别出 FN 结果。这产生了 39%的敏感性、63%的特异性、70%的 PPV、31%的 NPV 和 46%的准确性。
三相骨扫描没有提供任何诊断益处，因为没有结果能够明确区分感染相关和反应性变化。使用 Tc-99m-sulesomab 的抗粒细胞闪烁显像技术非常适合明确诊断与战斗相关的四肢感染。它在敏感性、特异性、PPV、NPV 和准确性方面均优于 CT。
