Cai Angela, Bakhshi Mehrshad, Lamarche Yoan, Harel Francois, Pelletier-Galarneau Matthieu
Department of Medical Imaging, Montreal Heart Institute, Montreal, QC, H1T 1C8, Canada.
Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada.
EJNMMI Rep. 2025 Feb 8;9(1):6. doi: 10.1186/s41824-024-00237-1.
Sternal wound infections (SWI) are complications of sternotomy and can be divided into deep SWI (DSWI) and superficial SWI (SSWI). In recent years, the use of 18F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) in diagnosing infections and inflammation has expanded significantly, with a growing number of clinical indications. This study assesses FDG-PET/CT diagnostic role in DSWI detection, the evolution of FDG uptake intensity in patients without DSWI and the potential biomarkers for DSWIs prediction.
We conducted a single center prospective study of consecutive patients referred for suspected SWI post-median sternotomy. Gold standard diagnosis was established by chart review of clinical follow-up, surgical findings, and cultures. To characterize the time between sternotomy and imaging, participants were subsequently subdivided into recent (< 3 months) or remote surgery (≥ 3 months) groups.
44 FDG-PET/CT scans, 12 (27%) of which had DSWI according to the gold standard, were collected and analyzed. 20 studies were assigned to the recent group, and 24 studies to the remote surgery group. Sensitivity and specificity of FDG-PET/CT for detection of DSWI were 67% and 66%, respectively and an accuracy of 66% was obtained. Positive and negative predictive values were 42% and 84%, respectively. The NPV was higher in the remote surgery group (100%) compared to the recent surgery group (73%). SUV of the median sternal wound was significantly higher in the DSWI (9.3 ± 2.3) than the non-DSWI group (7.1 ± 3.0) (p = 0.025). There was however significant overlap of SUV between the two groups. CRP, WBC counts, and PCT levels were not significantly different between the DSWI and non-DSWI groups (p ≥ 0.34).
FDG-PET/CT has modest sensitivity and specificity for the detection of DSWI post-sternotomy. FDG-PET/CT results must take into account time since surgery; when PET/CT is performed more than 3 months following surgery, a negative scan can exclude DSWI with a high level of certainty.
胸骨伤口感染（SWI）是胸骨切开术的并发症，可分为深部SWI（DSWI）和浅表SWI（SSWI）。近年来，18F-氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）/计算机断层扫描（CT）在感染和炎症诊断中的应用显著扩展，临床适应症不断增加。本研究评估FDG-PET/CT在DSWI检测中的诊断作用、无DSWI患者FDG摄取强度的变化以及DSWI预测的潜在生物标志物。
我们对连续接受正中胸骨切开术后疑似SWI的患者进行了单中心前瞻性研究。通过对临床随访、手术结果和培养物的图表审查建立金标准诊断。为了描述胸骨切开术与成像之间的时间，参与者随后被分为近期（<3个月）或远期手术（≥3个月）组。
收集并分析了44例FDG-PET/CT扫描，其中12例（27%）根据金标准诊断为DSWI。20项研究被分配到近期组，24项研究被分配到远期手术组。FDG-PET/CT检测DSWI的敏感性和特异性分别为67%和66%，准确率为66%。阳性和阴性预测值分别为42%和84%。远期手术组的阴性预测值（100%）高于近期手术组（73%）。DSWI组正中胸骨伤口的SUV（9.3±2.3）显著高于非DSWI组（7.1±3.0）（p=0.025）。然而，两组之间的SUV有显著重叠。DSWI组和非DSWI组之间的CRP、白细胞计数和PCT水平无显著差异（p≥0.34）。
FDG-PET/CT对胸骨切开术后DSWI的检测具有中等的敏感性和特异性。FDG-PET/CT结果必须考虑手术时间；术后3个月以上进行PET/CT检查时，阴性扫描可高度确定地排除DSWI。
