Cargando…
The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections
PURPOSE: (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG PET/CT) is frequently used to diagnose fracture-related infections (FRIs), but its diagnostic performance in this field is still unknown. The aims of this study were: (1) to assess the diagnostic performance of qualitative ass...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450834/ https://www.ncbi.nlm.nih.gov/pubmed/30523391 http://dx.doi.org/10.1007/s00259-018-4218-6 |
_version_ | 1783409075197837312 |
---|---|
author | Lemans, Justin V. C. Hobbelink, Monique G. G. IJpma, Frank F. A. Plate, Joost D. J. van den Kieboom, Janna Bosch, Paul Leenen, Luke P. H. Kruyt, Moyo C. Glaudemans, Andor W. J. M. Govaert, Geertje A. M. |
author_facet | Lemans, Justin V. C. Hobbelink, Monique G. G. IJpma, Frank F. A. Plate, Joost D. J. van den Kieboom, Janna Bosch, Paul Leenen, Luke P. H. Kruyt, Moyo C. Glaudemans, Andor W. J. M. Govaert, Geertje A. M. |
author_sort | Lemans, Justin V. C. |
collection | PubMed |
description | PURPOSE: (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG PET/CT) is frequently used to diagnose fracture-related infections (FRIs), but its diagnostic performance in this field is still unknown. The aims of this study were: (1) to assess the diagnostic performance of qualitative assessment of (18)F-FDG PET/CT scans in diagnosing FRI, (2) to establish the diagnostic performance of standardized uptake values (SUVs) extracted from (18)F-FDG PET/CT scans and to determine their associated optimal cut-off values, and (3) to identify variables that predict a false-positive (FP) or false-negative (FN) (18)F-FDG PET/CT result. METHODS: This retrospective cohort study included all patients with suspected FRI undergoing (18)F-FDG PET/CT between 2011 and 2017 in two level-1 trauma centres. Two nuclear medicine physicians independently reassessed all (18)F-FDG PET/CT scans. The reference standard consisted of the result of at least two deep, representative microbiological cultures or the presence/absence of clinical confirmatory signs of FRI (AO/EBJIS consensus definition) during a follow-up of at least 6 months. Diagnostic performance in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was calculated. Additionally, SUVs were measured on (18)F-FDG PET/CT scans. Volumes of interest were drawn around the suspected and corresponding contralateral areas to obtain absolute values and ratios between suspected and contralateral areas. A multivariable logistic regression analysis was also performed to identify the most important predictor(s) of FP or FN (18)F-FDG PET/CT results. RESULTS: The study included 156 (18)F-FDG PET/CT scans in 135 patients. Qualitative assessment of (18)F-FDG PET/CT scans showed a sensitivity of 0.89, specificity of 0.80, PPV of 0.74, NPV of 0.91 and diagnostic accuracy of 0.83. SUVs on their own resulted in lower diagnostic performance, but combining them with qualitative assessments yielded an AUC of 0.89 compared to an AUC of 0.84 when considering only the qualitative assessment results (p = 0.007). (18)F-FDG PET/CT performed <1 month after surgery was found to be the independent variable with the highest predictive value for a false test result, with an absolute risk of 46% (95% CI 27–66%), compared with 7% (95% CI 4–12%) in patients with (18)F-FDG PET/CT performed 1–6 months after surgery. CONCLUSION: Qualitative assessment of (18)F-FDG PET/CT scans had a diagnostic accuracy of 0.83 and an excellent NPV of 0.91 in diagnosing FRI. Adding SUV measurements to qualitative assessment provided additional accuracy in comparison to qualitative assessment alone. An interval between surgery and (18)F-FDG PET/CT of <1 month was associated with a sharp increase in false test results. |
format | Online Article Text |
id | pubmed-6450834 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-64508342019-04-17 The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections Lemans, Justin V. C. Hobbelink, Monique G. G. IJpma, Frank F. A. Plate, Joost D. J. van den Kieboom, Janna Bosch, Paul Leenen, Luke P. H. Kruyt, Moyo C. Glaudemans, Andor W. J. M. Govaert, Geertje A. M. Eur J Nucl Med Mol Imaging Original Article PURPOSE: (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG PET/CT) is frequently used to diagnose fracture-related infections (FRIs), but its diagnostic performance in this field is still unknown. The aims of this study were: (1) to assess the diagnostic performance of qualitative assessment of (18)F-FDG PET/CT scans in diagnosing FRI, (2) to establish the diagnostic performance of standardized uptake values (SUVs) extracted from (18)F-FDG PET/CT scans and to determine their associated optimal cut-off values, and (3) to identify variables that predict a false-positive (FP) or false-negative (FN) (18)F-FDG PET/CT result. METHODS: This retrospective cohort study included all patients with suspected FRI undergoing (18)F-FDG PET/CT between 2011 and 2017 in two level-1 trauma centres. Two nuclear medicine physicians independently reassessed all (18)F-FDG PET/CT scans. The reference standard consisted of the result of at least two deep, representative microbiological cultures or the presence/absence of clinical confirmatory signs of FRI (AO/EBJIS consensus definition) during a follow-up of at least 6 months. Diagnostic performance in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was calculated. Additionally, SUVs were measured on (18)F-FDG PET/CT scans. Volumes of interest were drawn around the suspected and corresponding contralateral areas to obtain absolute values and ratios between suspected and contralateral areas. A multivariable logistic regression analysis was also performed to identify the most important predictor(s) of FP or FN (18)F-FDG PET/CT results. RESULTS: The study included 156 (18)F-FDG PET/CT scans in 135 patients. Qualitative assessment of (18)F-FDG PET/CT scans showed a sensitivity of 0.89, specificity of 0.80, PPV of 0.74, NPV of 0.91 and diagnostic accuracy of 0.83. SUVs on their own resulted in lower diagnostic performance, but combining them with qualitative assessments yielded an AUC of 0.89 compared to an AUC of 0.84 when considering only the qualitative assessment results (p = 0.007). (18)F-FDG PET/CT performed <1 month after surgery was found to be the independent variable with the highest predictive value for a false test result, with an absolute risk of 46% (95% CI 27–66%), compared with 7% (95% CI 4–12%) in patients with (18)F-FDG PET/CT performed 1–6 months after surgery. CONCLUSION: Qualitative assessment of (18)F-FDG PET/CT scans had a diagnostic accuracy of 0.83 and an excellent NPV of 0.91 in diagnosing FRI. Adding SUV measurements to qualitative assessment provided additional accuracy in comparison to qualitative assessment alone. An interval between surgery and (18)F-FDG PET/CT of <1 month was associated with a sharp increase in false test results. Springer Berlin Heidelberg 2018-12-07 2019 /pmc/articles/PMC6450834/ /pubmed/30523391 http://dx.doi.org/10.1007/s00259-018-4218-6 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Lemans, Justin V. C. Hobbelink, Monique G. G. IJpma, Frank F. A. Plate, Joost D. J. van den Kieboom, Janna Bosch, Paul Leenen, Luke P. H. Kruyt, Moyo C. Glaudemans, Andor W. J. M. Govaert, Geertje A. M. The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections |
title | The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections |
title_full | The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections |
title_fullStr | The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections |
title_full_unstemmed | The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections |
title_short | The diagnostic accuracy of (18)F-FDG PET/CT in diagnosing fracture-related infections |
title_sort | diagnostic accuracy of (18)f-fdg pet/ct in diagnosing fracture-related infections |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450834/ https://www.ncbi.nlm.nih.gov/pubmed/30523391 http://dx.doi.org/10.1007/s00259-018-4218-6 |
work_keys_str_mv | AT lemansjustinvc thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT hobbelinkmoniquegg thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT ijpmafrankfa thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT platejoostdj thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT vandenkieboomjanna thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT boschpaul thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT leenenlukeph thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT kruytmoyoc thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT glaudemansandorwjm thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT govaertgeertjeam thediagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT lemansjustinvc diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT hobbelinkmoniquegg diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT ijpmafrankfa diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT platejoostdj diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT vandenkieboomjanna diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT boschpaul diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT leenenlukeph diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT kruytmoyoc diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT glaudemansandorwjm diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections AT govaertgeertjeam diagnosticaccuracyof18ffdgpetctindiagnosingfracturerelatedinfections |