评估诊断准确性:18F-FDG PET-CT 扫描在创伤后长骨非畸形中低度感染检测中的应用;文献综述和临床数据

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE Injury-International Journal of the Care of the Injured Pub Date : 2024-11-01 DOI:10.1016/j.injury.2024.111712
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引用次数: 0

摘要

导言由于没有临床症状,创伤后长骨非骨髁低位感染的诊断面临挑战。本研究旨在回顾有关低位感染影像学技术诊断准确性的现有文献,并评估 18F-FDG PET-CT 扫描对创伤后长骨非骨关节低位感染的诊断准确性。该研究是一项回顾性研究,包括疑似感染的长骨不连体成年患者。所有患者在手术治疗前均接受了 18F-FDG PET-CT 扫描作为指标检测,手术期间获得的围手术期培养物作为参考标准。通过 18F-FDG PET-CT 扫描获得的标准化摄取值 (SUV) 测量值进行定量分析。计算了诊断准确性指标,包括敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)。结果文献表明,18F-FDG PET-CT 是检测低级别感染最准确的成像技术。该研究共纳入了 51 例 18F-FDG PET-CT 扫描和 50 例长骨非关节炎患者的培养物。诊断准确率为 0.67(95 % CI 0.44-0.87)。计算得出的 PPV 和 NPV 分别为 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出较低的准确性,所有曲线下面积(AUC)值均为0.75,ROC曲线显示出与对角线相当平行的轨迹。需要对扫描结果进行仔细解读,可能还需要对示踪剂摄取量进行定量分析作为辅助手段。不过,这种情况的诊断准确性不如早发性 FRI 病例,在治疗这些具有挑战性的病例时应考虑到这一点。
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Assessing diagnostic accuracy: 18F-FDG PET-CT scans in low-grade infection detection among post-traumatic long bone non-unions; a literature review and clinical data

Introduction

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 18F-FDG PET-CT scans for low-grade infection in post-traumatic long bone non-unions.

Methods

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 18F-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 18F-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.

Results

Literature suggests that 18F-FDG PET-CT is the most accurate imaging technique to detect low-grade infections. The study included a total of 51 18F-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.

Conclusion and discussion

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 18F-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.
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
期刊最新文献
Editorial Board Fracture-related infection blood-based biomarkers: Diagnostic strategies The value of current diagnostic techniques in the diagnosis of fracture-related infections: Serum markers, histology, and cultures Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria In vivo models of infection: Large animals – Mini review on human-scale one-stage revision in a porcine osteomyelitis model
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