[18F]FDG PET/CT 成像与降低化脓性脊柱盘炎患者住院死亡率有关--对 29,362 例病例的登记分析

Siegmund Lang, Nike Walter, Stefanie Heidemanns, Constantin Lapa, Melanie Schindler, Jonas Krueckel, Nils Ole Schmidt, Dirk Hellwig, Volker Alt, Markus Rupp
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Diagnostic modalities were compared for their association with in-hospital mortality, with a focus on [18F]FDG PET/CT. Results: In total, 29,362 hospital admissions from 2019 to 2021 were analyzed. Of these, 60.1% were male and 39.9% were female, and 71.8% of the patients were aged 65 years and above. The overall in-hospital mortality rate was 6.5% for the entire cohort and 8.2% for the geriatric subgroup (p < 0.001). Contrast-enhanced (ce) MRI (48.1%) and native CT (39.4%) of the spine were the most frequently conducted diagnostic modalities. [18F]FDG PET/CT was performed in 2.7% of cases. CeCT was associated with increased in-hospital mortality (OR = 2.03, 95% CI: 1.90–2.17, p < 0.001). Cases with documented [18F]FDG PET/CT showed a lower frequency of in-hospital deaths (OR = 0.58, 95% CI: 0.18–0.50; p = 0.002). This finding was more pronounced in patients aged 65 and above (OR = 0.42, 95% CI: 0.27–0.65, p = 0.001). 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摘要

背景:虽然核磁共振成像是诊断脊柱盘炎的主要诊断工具,但[18F]-氟脱氧葡萄糖([18F]FDG)PET/CT的作用正日益突出。本研究旨在确定[18F]FDG PET/CT 的使用频率及其对脊柱盘炎患者院内死亡率的影响,尤其是对老年患者的影响。方法:我们在 2019 年至 2021 年期间使用全德国的开放式数据库开展了一项横断面研究,分析了 ICD-10 编码为 M46.2-、M46.3- 和 M46.4-("椎体骨髓炎"、"椎间盘感染(化脓性)"和 "未指定的椎间盘炎")的病例。比较了诊断方法与院内死亡率的关系,重点是[18F]FDG PET/CT。结果:共分析了 2019 年至 2021 年期间的 29,362 例住院病例。其中,60.1%为男性,39.9%为女性,71.8%的患者年龄在65岁及以上。整个队列的总体院内死亡率为 6.5%,老年亚组为 8.2%(P < 0.001)。脊柱对比增强(ce)磁共振成像(48.1%)和原始 CT(39.4%)是最常用的诊断方式。2.7%的病例进行了[18F]FDG PET/CT检查。CeCT与院内死亡率增加有关(OR = 2.03,95% CI:1.90-2.17,p < 0.001)。有[18F]FDG PET/CT记录的病例院内死亡频率较低(OR = 0.58,95% CI:0.18-0.50;P = 0.002)。这一结果在 65 岁及以上的患者中更为明显(OR = 0.42,95% CI:0.27-0.65,p = 0.001)。结论尽管[18F]FDG PET/CT并不经常使用,但它与脊柱盘炎患者较低的院内死亡率有关,尤其是在老年组群中。这项研究的局限性在于只考虑了住院患者的数据,并且依赖于无差错编码的假设。要优化脊柱盘炎的诊断方法,还需要进一步的研究。
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[18F]FDG PET/CT Imaging Is Associated with Lower In-Hospital Mortality in Patients with Pyogenic Spondylodiscitis—A Registry-Based Analysis of 29,362 Cases
Background: While MRI is the primary diagnostic tool for the diagnosis of spondylodiscitis, the role of [18F]-fluorodeoxyglucose ([18F]FDG) PET/CT is gaining prominence. This study aimed to determine the frequency of [18F]FDG PET/CT usage and its impact on the in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric population. Methods: We conducted a Germany-wide cross-sectional study from 2019 to 2021 using an open-access, Germany-wide database, analyzing cases with ICD-10 codes M46.2-, M46.3-, and M46.4- (‘Osteomyelitis of vertebrae’, ‘Infection of intervertebral disc (pyogenic)’, and ‘Discitis unspecified’). Diagnostic modalities were compared for their association with in-hospital mortality, with a focus on [18F]FDG PET/CT. Results: In total, 29,362 hospital admissions from 2019 to 2021 were analyzed. Of these, 60.1% were male and 39.9% were female, and 71.8% of the patients were aged 65 years and above. The overall in-hospital mortality rate was 6.5% for the entire cohort and 8.2% for the geriatric subgroup (p < 0.001). Contrast-enhanced (ce) MRI (48.1%) and native CT (39.4%) of the spine were the most frequently conducted diagnostic modalities. [18F]FDG PET/CT was performed in 2.7% of cases. CeCT was associated with increased in-hospital mortality (OR = 2.03, 95% CI: 1.90–2.17, p < 0.001). Cases with documented [18F]FDG PET/CT showed a lower frequency of in-hospital deaths (OR = 0.58, 95% CI: 0.18–0.50; p = 0.002). This finding was more pronounced in patients aged 65 and above (OR = 0.42, 95% CI: 0.27–0.65, p = 0.001). Conclusions: Despite its infrequent use, [18F]FDG PET/CT was associated with a lower in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric cohort. This study is limited by only considering data on hospitalized patients and relying on the assumption of error-free coding. Further research is needed to optimize diagnostic approaches for spondylodiscitis.
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