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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...

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Autores principales: 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.
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
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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.
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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
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