Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
J Orthop Surg Res. 2023 Aug 30;18(1):640. doi: 10.1186/s13018-023-04061-4.
BACKGROUND: American Academy of Orthopaedic Surgeons (AAOS) has provided the guidelines for diagnosing a patient with periprosthetic joint infection including the use of positron emission tomography/computed tomography (PET/CT). Systematic evidence focussing on periprosthetic joint infection (PJI) of hip is limited, which also contains limited number of studies. Hence, the current study aims to perform a pooled analysis of all studies that have assessed the diagnostic accuracy of PET/CT for PJI of hip. METHODS: Searches were done in PubMed Central, EMBASE, MEDLINE, SCOPUS and Cochrane library until December 2022. Meta-analysis was carried out using random-effects model. With 95% confidence intervals (CIs), pooled sensitivity and specificity were reported. RESULTS: Twenty-six studies met the inclusion criteria. The pooled sensitivity of PET/CT was 89% (95% CI 84-93%), while the pooled specificity was 86% (95% CI 79-91%). The AUROC was 0.94 (95% CI 0.72-0.99). There was statistically significant heterogeneity (p < 0.001) with I2 value of 96%. The diagnostic odds ratio was 52 (95% CI 26-106). Likelihood ratio positive was 6.5 (95% CI 4.1-10.3) and negative was 0.13 (95% CI 0.08-0.19). CONCLUSION: Our study found that PET/CT was found to have higher level of accuracy in terms of sensitivity and specificity. Further large-scale research can help to find answers for such questions and provide final conclusive evidence on the inclusion of the imaging modality into the routine clinical practice guidelines for suspected periprosthetic joint infection patients.
背景:美国骨科医师学会(AAOS)已经提供了诊断人工关节周围感染患者的指南,包括使用正电子发射断层扫描/计算机断层扫描(PET/CT)。针对髋关节人工关节周围感染(PJI)的系统证据有限,且其中包含的研究数量也有限。因此,本研究旨在对所有评估 PET/CT 对髋关节 PJI 诊断准确性的研究进行汇总分析。
方法:在 PubMed Central、EMBASE、MEDLINE、SCOPUS 和 Cochrane 图书馆进行检索,检索时间截至 2022 年 12 月。使用随机效应模型进行荟萃分析。以 95%置信区间(CI)报告汇总敏感性和特异性。
结果:26 项研究符合纳入标准。PET/CT 的汇总敏感性为 89%(95%CI 84-93%),而汇总特异性为 86%(95%CI 79-91%)。AUROC 为 0.94(95%CI 0.72-0.99)。存在统计学显著的异质性(p<0.001),I2 值为 96%。诊断比值比为 52(95%CI 26-106)。阳性似然比为 6.5(95%CI 4.1-10.3),阴性似然比为 0.13(95%CI 0.08-0.19)。
结论:我们的研究发现,PET/CT 在敏感性和特异性方面具有更高的准确性水平。进一步的大规模研究可以帮助回答这些问题,并为将该影像学方法纳入疑似人工关节周围感染患者的常规临床实践指南提供最终确凿证据。
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