Guhlmann A, Brecht-Krauss D, Suger G, Glatting G, Kotzerke J, Kinzl L, Reske S N
Department of Nuclear Medicine, University of Ulm, Germany.
J Nucl Med. 1998 Dec;39(12):2145-52.
The aim of this study was to assess the usefulness of PET with 2-18F-fluoro-2-deoxy-D-glucose (FDG), as compared to immunoscintigraphy (IS) with 99mTc-labeled monoclonal antigranulocyte antibodies (AGAbs), in the detection of chronic osteomyelitis.
Fifty-one patients suspected of having chronic osteomyelitis in the peripheral (n = 36) or central (n = 15) skeleton were evaluated prospectively with static FDG PET imaging and combined 99mTc-AGAb/99mTc-methylene diphosphonate (MDP) bone scanning within 5 days. FDG PET and IS were evaluated in a blinded and independent manner by visual interpretation, which was graded on a five-point scale of two observers' confident diagnosis of osteomyelitis. Receiver operating characteristic (ROC) curve analysis was performed for both imaging modalities. The final diagnosis was established by means of bacteriologic culture of surgical specimens and histopathologic analysis (n = 31) or by biopsy and clinical follow-up over 2 yr (n = 20).
Of 51 patients, 28 had osteomyelitis and 23 did not. According to the unanimous evaluation of both readers, FDG PET correctly identified 27 of the 28 positives and 22 of the 23 negatives (IS identified 15 of 28 positives and 17 of 23 negatives, respectively). The area under the ROC curve was 0.97/0.97 (reader 1/reader 2) for FDG PET and 0.87/0.90 for IS, with a high degree of interobserver concordance (K-values were 0.96 for FDG PET and 0.91 for IS). In the central skeleton, the ROC curve area was 0.98/1.00 for FDG PET and 0.71/0.77 for IS (p<0.05). On the basis of ROC analysis, the overall accuracies of FDG PET and IS in the detection of chronic osteomyelitis were 96%/96% and 82%/ 88%, respectively. With regard to the optimal threshold values, sensitivity and specificity were 100%/97% and 95%/95% with FDG PET, compared to 86%/92% and 77%/82% with IS, respectively.
In the peripheral skeleton, both FDG PET and combined 99mTc-AGAb/99mTc-MDP scanning are appropriate imaging modalities to diagnose chronic osteomyelitis. FDG PET additionally allows reliable differentiation between osteomyelitis and infection of the surrounding soft tissue. In the central skeleton within active bone marrow, FDG PET is highly accurate and superior to AGAb imaging in the diagnosis of chronic osteomyelitis, which frequently presents as a nonspecific photopenic lesion at scintigraphy with labeled white blood cells.
本研究旨在评估与采用99mTc标记的单克隆抗粒细胞抗体（AGAbs）进行免疫闪烁显像（IS）相比，2-18F-氟-2-脱氧-D-葡萄糖（FDG）PET在慢性骨髓炎检测中的效用。
对51例怀疑患有外周（n = 36）或中央（n = 15）骨骼慢性骨髓炎的患者进行前瞻性评估，在5天内进行静态FDG PET显像以及联合99mTc-AGAb/99mTc-亚甲基二膦酸盐（MDP）骨扫描。由两名观察者对FDG PET和IS进行盲法独立视觉解读评估，根据对骨髓炎的确诊信心采用五点量表评分。对两种成像方式均进行受试者操作特征（ROC）曲线分析。最终诊断通过手术标本的细菌培养和组织病理学分析（n = 31）或活检及2年的临床随访（n = 20）确定。
51例患者中，28例患有骨髓炎，23例未患。根据两位阅片者的一致评估，FDG PET正确识别出28例阳性中的27例以及23例阴性中的22例（IS分别识别出28例阳性中的15例以及23例阴性中的17例）。FDG PET的ROC曲线下面积为0.97/0.97（阅片者1/阅片者2），IS为0.87/0.90，观察者间一致性较高（FDG PET的K值为0.96，IS为0.91）。在中央骨骼中，FDG PET的ROC曲线面积为0.98/1.00，IS为0.71/0.77（p<0.05）。基于ROC分析，FDG PET和IS在检测慢性骨髓炎方面的总体准确率分别为96%/96%和82%/88%。关于最佳阈值，FDG PET的敏感性和特异性分别为100%/97%和95%/95%，而IS分别为86%/92%和77%/82%。
在外周骨骼中，FDG PET以及联合99mTc-AGAb/99mTc-MDP扫描都是诊断慢性骨髓炎的合适成像方式。FDG PET还能可靠地区分骨髓炎与周围软组织感染。在活跃骨髓内的中央骨骼中，FDG PET在诊断慢性骨髓炎方面高度准确且优于AGAb显像，慢性骨髓炎在标记白细胞闪烁显像时常表现为非特异性放射性缺损灶。
