Orthopaedic Department, Western Health, 160 Gordon Street, Footscray, Victoria, 3011, Australia.
Department of Medicine, University of Sydney, Sydney, Australia.
Skeletal Radiol. 2019 Oct;48(10):1565-1572. doi: 10.1007/s00256-019-03215-y. Epub 2019 Apr 12.
The aim of this study was to compare the diagnostic accuracy of nuclear imaging modalities in the detection of aseptic loosening of total knee arthroplasty (TKA).
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from database inception to December 2018 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies compared the results of a single imaging modality against an appropriate reference standard of prosthetic TKA loosening, with sufficient information to determine either sensitivity and/or specificity. The methodological quality of the studies was assessed using the QUADAS-2 tool.
The search strategy identified 572 abstracts. Of these, 12 studies comprising 401 patients across four modalities (bone scintigraphy, 18F-FDG-PET, SPECT/CT arthrogram, radionuclide arthrogram) met the inclusion criteria. All included studies used operative findings, a period of clinical or radiographic observation or both as a reference standard for aseptic loosening. Sixteen comparisons with the reference standards were extracted. All studies were at risk of bias across patient selection, the index test, reference standard, and flow and timing of patients. The most accurate test for diagnosis of aseptic loosening in TKA was SPECT/CT arthrography demonstrated by the summary receiver operating characteristic curve.
The best available evidence suggests the most accurate modality for the detection of aseptic loosening in TKA is SPECT/CT arthrography. However, the available evidence has a high risk of bias, and total number of patients studied for each modality is small so further studies are warranted.
本研究旨在比较核医学成像方式在全膝关节置换术（TKA）无菌性松动检测中的诊断准确性。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，从数据库建立到 2018 年 12 月，在 MEDLINE、EMBASE 和 Cochrane 系统评价数据库中进行了搜索。纳入的研究将单一成像方式的结果与适当的假体 TKA 松动参考标准进行了比较，这些研究提供了足够的信息来确定敏感性和/或特异性。使用 QUADAS-2 工具评估研究的方法学质量。
搜索策略确定了 572 篇摘要。其中，有 12 项研究包括 401 名患者，涉及四种方式（骨闪烁扫描、18F-FDG-PET、SPECT/CT 关节造影术、放射性核素关节造影术），符合纳入标准。所有纳入的研究均使用手术结果、临床或影像学观察期或两者作为无菌性松动的参考标准。共提取了 16 项与参考标准的比较。所有研究在患者选择、指数检验、参考标准以及患者的流程和时间方面都存在偏倚风险。SPECT/CT 关节造影术是诊断 TKA 无菌性松动最准确的检查方法，这是通过汇总受试者工作特征曲线得出的结论。
目前最好的证据表明，SPECT/CT 关节造影术是检测 TKA 无菌性松动最准确的方法。然而，现有的证据存在较高的偏倚风险，并且每种方式研究的患者总数较少，因此需要进一步的研究。
