^(18)F-FDG符合线路显像联合滑液CRP检测诊断膝关节假体感染

Efficiency of ^(18)F-fluorodeoxyglucose coincidence imaging combined with synovial fluid CRP in diagnosis of periprosthetic joint infection in knee

[目的]探讨^(18)F-FDG符合线路显像联合滑液CRP检测在膝关节假体周围感染的诊断价值。[方法]回顾性分析87例高度疑诊为膝关节假体周围感染患者,术前行^(18)F-FDG显像符合线路显像(^(18)F-FDG显像)及滑液CRP检测,术中采集假体周围5个不同部位的滑液进行细菌培养,培养结果为阴性的延长培养时间至2周,以细菌培养最终检验结果作为诊断标准。分析比较联合检查、单纯^(18)F-FDG显像和单纯滑液CPR的诊断价值及意义。[结果]87例患者中,细菌培养阳性73例,确诊为假体感染(感染组);14例为阴性,排除假体感染(非感染组)。联合检查的敏感性为89.04%,特异性为92.86%,准确性为89.66%;单纯^(18)F-FDG显像的敏感性为87.67%,特异性为71.43%,准确性为85.06%;单纯滑液CPR的敏感性为90.41%,特异性为57.14%,准确性为82.76%。联合检查的特异性和准确性显著高于单纯^(18)F-FDG显像或单纯滑液CRP检测,差异具有统计学意义(P<0.05)。[结论]^(18)FFDG符合线路显像联合滑液CRP检测显著改进膝关节假体周围感染诊断的特异性和准确性,可为膝关节假体周围感染诊断提供依据。

[Objective] To investigate the efficiency of ^18F-fluorodeoxyglucose （^18F-FDG） coincidence imaging combined with synovial CRP （the combined assay） for diagnosis of periprosthetic joint infection （PJI） of the knee. [Methods] A retrospec- tive study was done on 87 patients who were highly suspected as periprosthetic infection. The ^18F-FDG imaging and synovial CPR were taken before revision surgery, and then bacterial culture was conducted using the tissue samples obtained from 5 different periprosthetic parts during operation. If it was negative, the culture was extended to 2 weeks, and the final results were used as analytical criteria to evaluate the efficacy and significance of the preoperative assays. [Results] Among the 87 patients, 73 patients got positive results of bacterial culture （the PJI group）, while the remaining 14 patients proved negative （the non PJI group） . The combined assay achieved sensitivity of 89.04%, specificity of 92.86%, and accuracy of 89.66%. By contrast, the mere is F-FDG imaging got sensitivity of 87.67%, specificity of 71.43%, and accuracy of 85.06%, whereas the synovial CPR only had sensitivity of 90.41%, specificity of 57.14%, and accuracy of 82.76%. The combined assay was statistically superior to the mere ^18F-FDG imaging and the synovial CPR only in specificity and accuracy for diagnosis of PJI （P〈0.05）. [Conclusion] The ^18F-fluorodeoxyglucose coincidence imaging combined with synovial CRP achieves highly improved specificity and accura- cy in diagnosis of periprosthetic joint infection of the knee.