Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Department of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Department of Radiology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Injury. 2024 Nov;55 Suppl 6:111712. doi: 10.1016/j.injury.2024.111712.
The diagnosis of low-grade infection in post-traumatic long bone non-unions poses challenges due to the absence of clinical signs. This study aimed to review the available literature on the diagnostic accuracy of imaging techniques for low-grade infections and assess the diagnostic accuracy of F-FDG PET-CT scans for low-grade infection in post-traumatic long bone non-unions.
A mini-review was conducted using Pubmed in March 2024. A retrospective study was conducted including adult patients with a long bone non-union, suspected of infection. All patients underwent F-FDG PET-CT scans as the index test before surgical intervention, with peri‑operative cultures obtained during surgery serving as the reference standard. Quantitative analyses were performed on the standardized uptake value (SUV) measurements obtained from the F-FDG PET-CT scans. Diagnostic accuracy measures including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the discriminatory ability of SUV measurements.
Literature suggests that F-FDG PET-CT is the most accurate imaging technique to detect low-grade infections. The study included a total of 51 F-FDG PET-CT scans and cultures from 50 patients with long bone non-unions. The diagnostic accuracy was found to be 0.67 (95 % CI 0.44-0.87). The PPV and NPV were calculated as 0.79 (95 % CI 0.53-1.00) and 0.52 (95 % CI 0.30-0.73), respectively. Quantitative analyses of SUV measurements demonstrated a low level of accuracy, with all area under the curve (AUC) values < 0.75 and ROC curves showing a trajectory fairly parallel to the diagonal line.
The findings of this study indicate that in post-traumatic long bone non-unions, where a low-grade fracture-related infection (FRI) is suspected, the F-FDG PET-CT has a performance that is advantageous over other imaging techniques. A careful interpretation of the scan results is warranted, possibly including the quantitative analysis on tracer uptake as an adjunct. Nevertheless, the diagnostic accuracy in this condition is not as good as in early-onset FRI cases, and this should be taken into account when treating these challenging cases.
创伤后长骨骨不连中低度感染的诊断具有挑战性，因为缺乏临床体征。本研究旨在回顾现有文献中关于影像学技术诊断低度感染的准确性，并评估 F-FDG PET-CT 扫描在创伤后长骨骨不连中诊断低度感染的准确性。
2024 年 3 月，使用 Pubmed 进行小型综述。进行了一项回顾性研究，纳入了疑似感染的长骨骨不连的成年患者。所有患者在手术干预前均接受 F-FDG PET-CT 扫描作为参考测试，术中获得的围手术期培养物作为参考标准。对 F-FDG PET-CT 扫描获得的标准化摄取值（SUV）测量值进行定量分析。计算了灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）等诊断准确性指标。采用受试者工作特征（ROC）曲线分析评估 SUV 测量值的鉴别能力。
文献表明，F-FDG PET-CT 是检测低度感染最准确的影像学技术。该研究共纳入了 50 例长骨骨不连患者的 51 次 F-FDG PET-CT 扫描和培养物。诊断准确性为 0.67（95%CI 0.44-0.87）。PPV 和 NPV 分别计算为 0.79（95%CI 0.53-1.00）和 0.52（95%CI 0.30-0.73）。SUV 测量值的定量分析显示准确性较低，所有曲线下面积（AUC）值均<0.75，ROC 曲线显示轨迹相当平行于对角线。
本研究结果表明，在创伤后长骨骨不连中，疑似低度骨折相关感染（FRI）时，F-FDG PET-CT 的表现优于其他影像学技术。需要仔细解读扫描结果，可能包括作为辅助的示踪剂摄取的定量分析。然而，在这种情况下的诊断准确性不如早期 FRI 病例好，在治疗这些具有挑战性的病例时应考虑到这一点。
