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学科主题: 核医学
题名:
99Tcm-MDP骨三相定量法鉴别关节置换术后感染及松动
其他题名: Differentiation between peri-prosthetic infection and aseptic loosening using quantitative analysis of triphasic 99Tcm-MDP bone scintigraphy
作者: 李欣欣; 张燕燕; 张卫方; 毛远; 赵梅莘
关键词: 髋假体 ; 膝关节,人工 ; 感染 ; 放射性核素显像 ; MDP ; Hip prosthesis ; Knee prosthesis ; Infection ; Radionuclide imaging ; MDP
刊名: 中华核医学与分子影像杂志
发表日期: 2013
DOI: 10.3760/cma.j.issn.2095-2848.2013.06.009
卷: 33, 期:6, 页:437-439
收录类别: 中国科技核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 以定量法研究99Tcm-MDP骨三相显像在鉴别骨关节置换术后无菌性及感染性假体松动中的价值.方法 回顾性分析28例关节置换术后出现疼痛而再次就诊患者[男9例、女19例,年龄49~80(平均67.5)岁]的骨三相显像,在血流、血池、静态3个时相分别勾画患侧与健侧关节ROI,选区域内最大计数计算患侧与健侧比值.将各比值及血红细胞沉降率、C反应蛋白等检查结果进行ROC曲线分析.最终诊断以手术病理及细菌培养结果为准.各指标AUC越大,诊断效能越高,依据较为理想的灵敏度和特异性选择最佳截断值.结果 28例中,感染性松动者9例,无菌性松动17例,股骨大转子滑囊炎1例,缝线反应1例.如果以血流或血池显像阳性为诊断感染性松动的标准,骨显像的灵敏度、特异性及准确性分别为7/9,78.9%(15/19)和78.6%(22/28).血池相计数比值的ROC AUC为0.942,最佳截断值为1.40时灵敏度和特异性可达8/9和78.9%(15/19).血流相计数比值的ROC AUC为0.816,最佳截断值为1.53.C反应蛋白的ROC AUC为0.795,最佳截断值为1.20.血红细胞沉降率的ROC AUC为0.722,静态相计数比值的ROC AUC为0.474(均P>0.05).结论 以定量的方法分析骨三相显像在诊断假体置换术后有无合并感染,其诊断效能高于定性方法,其中血池显像的诊断价值最高. Objective To differentiate between peri-prosthetic infection and aseptic loosening using quantitative analysis of triphasic bone scintigraphy.Methods Twenty-eight patients (9 males,19 females; mean age 67.5 years,range 49-80 years) with recurrent joint pain after arthroplasty were retrospectively assessed.All patients underwent triphasic bone scintigraphy.ROI of each joint was drawn and the ratios of affected to unaffected side were calculated.The ratios of blood flow phase,blood pool phase,static phase,Creactive protein (CRP) and erythrocyte sedimentation (ESR) were quantitatively analyzed by ROC curve.The final diagnosis was based on microbiological and histological examinations.The optimal cut-off value was chosen based on the ideal sensitivity and specificity.Results Nine patients were diagnosed as septic loosening,17 patients aseptic loosening,1 patient bursitis of hip joint and 1 patient suture reaction.Taking the positive results of blood flow phase or blood pool phase as standard for diagnosing septic loosening,the sensitivity,specificity and accuracy of bone scintigraphy were 7/9,78.9% (15/19) and 78.6% (22/28),respectively.The AUC of blood pool phase was 0.942,and the sensitivity and specificity were 8/9 and 78.9%(15/19),respectively,with the optimal cut-off value of 1.40.The AUCs of blood flow ratio and CRP were 0.816 and 0.795,with cut-off values of 1.53 and 1.20,respectively.The AUCs of static phase ratio and ESR were 0.474 and 0.722,respectively,both P>0.05.Conclusions For the diagnosis of septic loosening,quantitative analysis of triphasic 99Tcm-MDP bone scintigraphy,particularly with the ratio of blood pool phase,is more accurate than qualitative analysis.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/70940
Appears in Collections:北京大学第三临床医学院_核医学科_期刊论文

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作者单位: 100191,北京大学第三医院核医学科

Recommended Citation:
李欣欣,张燕燕,张卫方,等. 99Tcm-MDP骨三相定量法鉴别关节置换术后感染及松动[J]. 中华核医学与分子影像杂志,2013,33(6):437-439.
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