Segawa Tomohide, Koga Hisashi, Oshina Masahito, Fukushima Masayoshi, Inanami Hirohiko
Department of Orthopedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.
Department of Orthopedic Surgery, Iwai Orthopedic Medical Hospital, Tokyo, Japan.
Spine (Phila Pa 1976). 2021 May 15;46(10):E602-E610. doi: 10.1097/BRS.0000000000003847.
Retrospective case series.
The purpose of this study was to assess the diagnostic yield of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for surgical site infection (SSI) after spine surgery.
Diagnosis of SSI in the spine based on F-18 FDG PET/CT requires experienced nuclear medical physicians for a detailed analysis of F-18 FDG distribution pattern. It has also been reported that increases in the maximal standardized uptake values of F-18 FDG (SUVmax) closely correlated with SSI, suggesting potential of more objective and quantitative diagnosis.
We assessed the diagnostic yield of F-18 FDG PET/CT (pattern-based diagnosis by nuclear medical physicians and SUVmax-based diagnosis) for SSI in 52 subjects who underwent spine surgery. The 52 subjects included 11 nonimplant and 41 implant cases. F-18 FDG PET/CT was performed in 33 and 19 cases in early (≤12 weeks after the surgery) and late (>12 weeks) phases, respectively. The final diagnosis of SSI was based on the results of pathogen identification, plain radiography, and CT and/or magnetic resonance imaging or response to antibiotics and/or reoperation.
SUVmax-based diagnosis was performed with a cut off value of 5.0 as determined by receiver operating characteristic analysis. Both pattern-based and SUVmax-based diagnoses demonstrated excellent diagnostic yields with high sensitivity (97% and 90%), specificity (100% and 100%), and accuracy (98% and 94%). High diagnostic yields (accuracy of ≥90%) were consistently observed irrespective of presence or absence of implantation or interval between surgery and F-18 FDG PET/CT.
F-18 FDG PET/CT can be the procedure of choice for investigation of SSI in the spine when other imaging fails to provide a definitive diagnosis.Level of Evidence: 4.
回顾性病例系列研究。
本研究旨在评估氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-18 FDG PET/CT）对脊柱手术后手术部位感染（SSI）的诊断效能。
基于F-18 FDG PET/CT诊断脊柱SSI需要经验丰富的核医学医师对F-18 FDG分布模式进行详细分析。也有报道称，F-18 FDG最大标准化摄取值（SUVmax）的升高与SSI密切相关，提示有更客观和定量诊断的潜力。
我们评估了F-18 FDG PET/CT（核医学医师基于模式的诊断和基于SUVmax的诊断）对52例行脊柱手术患者SSI的诊断效能。这52例患者包括11例非植入病例和41例植入病例。分别在33例和19例患者的早期（手术后≤12周）和晚期（>12周）进行了F-18 FDG PET/CT检查。SSI的最终诊断基于病原体鉴定、X线平片、CT和/或磁共振成像结果或对抗生素的反应和/或再次手术情况。
通过受试者工作特征分析确定基于SUVmax的诊断的截断值为5.0。基于模式的诊断和基于SUVmax的诊断均显示出优异的诊断效能，具有高敏感性（分别为97%和90%）、特异性（分别为100%和100%）和准确性（分别为98%和94%）。无论是否存在植入物或手术与F-18 FDG PET/CT之间的间隔时间如何，均始终观察到高诊断效能（准确性≥90%）。
当其他影像学检查未能提供明确诊断时，F-18 FDG PET/CT可作为脊柱SSI检查的首选方法。证据级别：4级。
