Comparative diagnostic accuracy of respective nuclear imaging for suspected fracture-related infection: a systematic review and Bayesian network meta-analysis

Zhang, Qingyu; Dong, Jinlei; Shen, Yelong; Yun, Canhua; Zhou, Dongsheng; Liu, Fanxiao

doi:10.1007/s00402-020-03506-3

Cited by 12 publications

(8 citation statements)

References 55 publications

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“…Nuclear imaging was available at all participating centers and all centers used the same imaging protocols [6] . WBC scan had a sensitivity of 50% and a specificity of 85%, which are lower than the pooled sensitivity and specificity rates described in a recent systematic review (86% and 96%, respectively) [21] . In the same systematic review 18 F-FDG-PET was associated with a pooled sensitivity and specificity of 93% and 79% [21] .…”

Section: Article In Presscontrasting

confidence: 75%

“…WBC scan had a sensitivity of 50% and a specificity of 85%, which are lower than the pooled sensitivity and specificity rates described in a recent systematic review (86% and 96%, respectively) [21] . In the same systematic review 18 F-FDG-PET was associated with a pooled sensitivity and specificity of 93% and 79% [21] . In our study, the sensitivity and specificity of 18 F-FDG-PET were 65.2% and 100%, respectively.…”

Section: Article In Presscontrasting

confidence: 75%

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Validation of the diagnostic criteria of the consensus definition of fracture-related infection

Onsea

Lieshout

Zalavras

et al. 2022

Injury

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Section: Article In Presscontrasting

confidence: 75%

Section: Article In Presscontrasting

confidence: 75%

Validation of the diagnostic criteria of the consensus definition of fracture-related infection

Onsea

Lieshout

Zalavras

et al. 2022

Injury

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“…To address this question scientifically, an updated pairwise meta-analysis was performed and the pooled results demonstrated that 18 F-FDG PET and PET/CT had satisfactory accuracy (sensitivity = 0.91, 95% CI: 0.84–0.95; specificity = 0.90, 95% CI: 0.79–0.95) in identifying or excluding suspected pyogenic spondylitis. These results are partly consistent with the previously reported accuracy of this imaging technique for diagnosing suspected fracture-related infection and periprosthetic joint infection [ 12 ].…”

Section: Discussionsupporting

confidence: 92%

“…Fluorine-18 fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) and PET/CT can be used to appraise increased glucose uptake and therefore are usually recommended to diagnose, stage, and detect the recurrence or progression of the malignant tumors [11]. Studies using this nuclear imaging technique to assess infection/inflammation are growing in recent years, especially for musculoskeletal infections [12]. Compared to CT and MRI, 18 F-FDG PET and PET/CT provide the advantages of whole-body coverage to detect unintended metastasis of infection, and fewer artifacts due to metallic implants.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography for suspected primary and postoperative pyogenic spondylitis

Feng

2023

J Orthop Surg Res

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Objective Fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) and PET/CT have been suggested for confirming or excluding musculoskeletal infection but the diagnostic value of this tool for pyogenic spondylitis remains to be confirmed. This meta-analysis was performed to verify the accuracy of 18F-FDG PET and PET/CT in diagnosing suspected pyogenic spondylitis by performing a systematic review and meta-analysis. Methods We conducted a comprehensive literature search of PubMed, Embase and Cochrane Library to retrieve diagnostic accuracy studies in which suspected pyogenic spondylitis was assessed with 18F-FDG PET or PET/CT. The pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), summarized receiver operating characteristic curve (sROC) and the area under the sROC (AUC) were calculated by using Stata software. Results A total of 18 eligible studies (660 patients) with suspected pyogenic spondylitis were included in the quantitative analysis. 18F-FDG PET and PET/CT illustrated relatively high sensitivity (0.91, 95% CI: 0.84–0.95) and specificity (0.90, 95% CI: 0.79–0.95) for the diagnosis of pyogenic spondylitis. The pooled DOR and AUC were 86.00 (95% CI, 31.00–240.00) and 0.96 (95% CI, 0.94–0.97), respectively. For diagnosing pyogenic spondylitis without previous spine surgery, the pooled sensitivity, specificity, DOR and AUC were 0.93 (95% CI, 0.85–0.97), 0.91 (95% CI, 0.77–0.97), 136 (95% CI, 35–530) and 0.97 (95% CI, 0.95–0.98), respectively. For diagnosing postoperative pyogenic spondylitis, the pooled sensitivity, specificity, DOR and AUC were 0.85 (95% CI, 0.71 to 0.93), 0.87 (95% CI, 0.66 to 0.96), 38 (95% CI, 9 to 167) and 0.92 (95% CI, 0.89 to 0.94), respectively. Conclusion 18F-FDG PET and PET/CT presented satisfactory accuracy for diagnosing pyogenic spondylitis. The diagnostic effect of this nuclear imaging method for pyogenic spondylitis without previous spine surgery seems to be better than that for the postoperative ones. However, whether 18F-FDG PET and PET/CT could become a routine in patients with suspected pyogenic spondylitis remains to be confirmed. Level of evidence Level I evidence, a summary of meta-analysis.

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“…Even though FDG-PET/CT and bone scintigraphy have shown a very high sensitivity in a recent meta-analysis to diagnose fracture related infections [19], in our analysis, both types of imaging failed to detect SII when caused by C. acnes. Probably due to the low-grade inflammation caused by C. acnes, these nuclear imaging modalities lack diagnostic power, as demonstrated also for chronic shoulder PJIs [20].…”

Section: Discussioncontrasting

confidence: 80%

A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma

et al. 2022

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Purpose To investigate if serum inflammatory markers or nuclear imaging can accurately diagnose a chronic spinal instrumentation infection (SII) prior to surgery. Methods All patients who underwent revision of spinal instrumentation after a scoliosis correction between 2017 and 2019, were retrospectively evaluated. The diagnostic accuracy of serum C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR), 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG–PET/CT) and Technetium-99m-methylene diphosphonate (99mTc-MDP) 3-phase bone scintigraphy (TPBS) to diagnose infection were studied. Patients with an acute infection or inadequate culture sampling were excluded. SII was diagnosed if ≥ 2 of the same microorganism(s) were isolated from intra-operative tissue cultures. Results 30 patients were included. The indication for revision surgery was pseudoarthrosis in the majority of patients (n = 15). 22 patients (73%) were diagnosed with SII. In all infected cases, Cutibacterium acnes was isolated, including 5 cases with a polymicrobial infection. The majority of patients had low inflammatory parameters preoperatively. For CRP > 10.0 mg/L, the sensitivity was 9.1% and specificity 100%; for ESR > 30 mm/h, the sensitivity was 9.1% and specificity 100%. The diagnostic accuracy for nuclear imaging was 64% for the FDG–PET/CT and 67% for the TPBS to diagnose infection. Conclusions The prevalence of SII in patients undergoing revision spinal surgery is high, with Cutibacterium acnes as the main pathogen. No diagnostic tests could be identified that could accurately diagnose or exclude SII prior to surgery. Future studies should aim to find more sensitive diagnostic modalities to detect low-grade inflammation.

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Comparative diagnostic accuracy of respective nuclear imaging for suspected fracture-related infection: a systematic review and Bayesian network meta-analysis

Cited by 12 publications

References 55 publications

Validation of the diagnostic criteria of the consensus definition of fracture-related infection

Validation of the diagnostic criteria of the consensus definition of fracture-related infection

Diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography for suspected primary and postoperative pyogenic spondylitis

A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma

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