^(18)F-FDG PET/CT对下肢开放骨折术后感染的定位诊断价值及引导作用

Applicability of ^(18)F-FDG PET/CT in patients with suspected local infection after open fractures of lower extremity

目的评价^(18)F-FDG PET/CT对下肢开放骨折术后感染的定位诊断价值及对清创术的引导作用。方法收集医院2018-07至2019-06收治的15例下肢外伤骨折术后可疑慢性局部感染患者资料,清创术前1周内接受18F-FDG PET/CT检查;根据PET/CT影像定位感染灶,并与术后病理、微生物培养结果及PET/CT对照;分别计算骨感染灶和软组织感染灶的平均SUV_(max),并与1例SPECT/CT骨显像进行对比分析;评价PET/CT引导下清创术的效果。结果15例中6例为单纯骨感染灶,3例为单纯软组织感染灶,6例同时存在骨感染灶及软组织感染灶;PET/CT共发现骨感染灶18处,软组织感染灶12处,其中骨感染灶SUV_(max)为5.1±3.4,软组织感染灶SUV_(max)为3.6±2.4;PET/CT对骨感染灶的诊断灵敏性为94.4%,对软组织感染灶的诊断灵敏性为83.3%;PET/CT诊断灵敏性高于SPECT/CT骨显像;经PET/CT引导下的一次清创治愈率为93.3%(14/15)。结论18F-FDG PET/CT诊断下肢开放骨折术后感染的准确性高,引导手术清创效果可靠。

Objective To evaluate the applicability of ^(18)F-FDG PET/CT in the positional diagnosis of postoperative infections of open fractures in lower extremities,and its role in debridement surgery.Methods Fifteen patients with suspected chronic local infections following surgeries for traumatic fractures of lower extremities were recruited between July 2018 and June 2019.PET/CT examination was performed one week before debridement.Infection lesions were positioned according to PET/CT images and compared with results of postoperative pathology,microbial culture and PET/CT.The mean SUV_(max) of bone infections and soft tissue infections was calculated,while the findings of PET/CT and SPECT/CT imaging of one patient were analyzed.The effect of PET/CT-guided debridement was assessed.Results Among the 15 patients,6 had simple bone infection lesions,3 had simple soft tissue infection lesions,and the other 6 patients had both bone infection lesions and soft tissue infection lesions.A total of 18 bone infection lesions and 12 soft tissue infection lesions were found by PET/CT.The SUV_(max) of bone infection lesions was 5.1±3.4,compared with 3.6±2.4 for soft tissue infection lesions.The diagnostic sensitivity of PET/CT for bone infections and soft tissue infections was 94.4%and 83.3%respectively.The sensitivity of PET/CT was higher than that of SPECT/CT imaging.Under the guidance of PET/CT,the cure rate of patients with open fractures in lower extremities after one debridement was 93.3%(14/15).Conclusions The accuracy of 18F-FDG PET/CT in the diagnosis of postoperative infections of open fractures of lower extremities is high,and the effect of guided debridement is reliable.