Hariri Hadi, Tan Stéphanie, Martineau Patrick, Lamarche Yoan, Carrier Michel, Finnerty Vincent, Authier Sébastien, Harel Francois, Pelletier-Galarneau Matthieu
1Department of Medical Imaging, Institut de cardiologie de Montréal, Montreal, Quebec, Canada.
2Department of Radiology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba Canada.
Nucl Med Mol Imaging. 2019 Aug;53(4):253-262. doi: 10.1007/s13139-019-00599-6. Epub 2019 Jun 14.
FDG-PET/CT has the potential to play an important role in the diagnosis of sternal wound infections (SWI). The purpose of this study was to analyze the diagnostic accuracy of FDG-PET/CT for SWI in patients following sternotomy.
We performed a single-center, retrospective analysis of patients who had undergone median sternotomy and FDG-PET/CT imaging. The gold standard consisted of positive bacterial culture and/or the presence of purulent material at surgery. Qualitative patterns of sternal FDG uptake, SUV, and associated CT findings were determined, and an imaging scoring system was developed. The diagnostic performances were studied in both the recent (≤ 6 months between sternotomy and imaging) and remote surgery phase (> 6 months).
A total of 40 subjects were identified with 11 confirmed SWI cases. Consensus interpretation was associated with a sensitivity of 91% and specificity of 97%. Combination of uptake patterns yielded an AUC of 0.96 while use of SUVmax yielded an AUC of 0.82.
Results suggest that FDG-PET/CT may be useful for the diagnosis of SWI with optimal diagnostic accuracy achieved by identifying specific patterns of uptake. SUV can be helpful in assessing subjects with remote surgery, but its use is limited in the context of recent surgery. Further studies are required to confirm these results.
氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG-PET/CT）在胸骨伤口感染（SWI）的诊断中可能发挥重要作用。本研究的目的是分析FDG-PET/CT对胸骨切开术后患者SWI的诊断准确性。
我们对接受正中胸骨切开术和FDG-PET/CT成像的患者进行了单中心回顾性分析。金标准包括手术时细菌培养阳性和/或存在脓性物质。确定胸骨FDG摄取的定性模式、标准化摄取值（SUV）及相关CT表现，并开发了一种影像评分系统。在近期（胸骨切开术与成像之间间隔≤6个月）和远期手术阶段（>6个月）对诊断性能进行了研究。
共纳入40名受试者，其中11例确诊为SWI。共识解读的敏感性为91%，特异性为97%。摄取模式组合的曲线下面积（AUC）为0.96，而使用最大SUV的AUC为0.82。
结果表明，FDG-PET/CT可能有助于SWI的诊断，通过识别特定的摄取模式可实现最佳诊断准确性。SUV有助于评估远期手术的受试者，但在近期手术的情况下其应用有限。需要进一步研究来证实这些结果。
