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Diagnostik der chronischen Osteitis des Extremitätenskeletts

Stellenwert der F-18-FDG-PET

Diagnosis of chronic osteitis of the bones in the extremities

Relative value of F-18 FDG-PET

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Zusammenfassung

Hintergrund

Die nichtinvasive Diagnostik bei chronischen Knocheninfektionen stellt noch immer eine Herausforderung dar. Als Goldstandard für die sichere Diagnose gilt der positive intraoperative mikrobiologische und/oder histologische Befund. Ziel der vorgelegten Studie war es, die Wertigkeit der Fluor-18-FDG-PET bei der Diagnostik der chronischen Osteitis am Patientengut einer Spezialabteilung für septisch-orthopädische Chirurgie zu evaluieren. Es sollte insbesondere die Frage beantwortet werden, ob die Befunde der FDG-PET mit den intraoperativ entnommenen Proben (Mikrobiologie, Histologie) korrelieren und welche Wertigkeit der Untersuchungsmethode im Vergleich zu Computertomographie (CT) und Magnetresonanztomographie (MRT) zukommt.

Material und Methoden

50 Patienten mit der Verdachtsdiagnose „chronische Osteitis des Extremitätenskeletts“ wurden präoperativ einer F-18-FDG-PET-Untersuchung unterzogen. Bei allen Patienten lag anamnestisch eine offene Fraktur und/oder eine vorangegangene Operation der betroffenen Extremität vor. Die Auswertung der FDG-PET-Befunde erfolgte verblindet, alle in die Studie aufgenommenen Patienten wurden in der Folge operiert. Die Ergebnisse der intraoperativ entnommenen histologischen und mikrobiologischen Proben wurden ebenso postoperativ mit den Ergebnissen der FDG-PET verglichen wie die zusätzlich erhobenen CT- (n=22) und MRT-Befunde (n=18). Schließlich wurden Sensitivität, Spezifität und Treffsicherheit für das jeweilige Verfahren bestimmt.

Ergebnisse

Postoperativ zeigten die Gewebeproben von 37 Patienten einen positiven mikrobiologischen und/oder histologischen Befund. Bei 13 Patienten konnte nach diesem Goldstandard eine Osteitis nicht nachgewiesen werden. 34 Patienten, deren mikrobiologischer und/oder histologischer Befund positiv ausfiel, wurden in der präoperativen FDG-PET-Befundung als richtig infektpositiv diagnostiziert. Es wurden 4 falsch-positive Befunde beobachtet. Falsch-negativ wurden 3, richtig-negativ 9 Patienten bewertet. Sensitivität, Spezifität und Treffsicherheit betrugen 92%, 69% bzw. 86% für das Gesamtkollektiv. Sensitivität, Spezifität und Treffsicherheit für die Computertomographie lagen bei 47%, 60% bzw. 50%, für die Magnetresonanztomographie bei 82%, 43% bzw. 67%.

Schlussfolgerung

Die F-18-FDG-PET ist ein vielversprechendes bildgebendes Verfahren in der Diagnostik der chronischen Osteitis mit hoher Sensitivität und Treffsicherheit. Bei negativem FDG-PET-Ergebnis kann eine chronische Osteitis nahezu ausgeschlossen werden. Nach den vorgelegten Ergebnissen ist das Verfahren den bildgebenden Verfahren CT und MRT hinsichtlich Sensitivität und Treffsicherheit überlegen. Der definitive Nachweis einer chronischen Osteitis erfolgt auch in Zukunft invasiv durch mikrobiologische und histologische Proben.

Abstract

Background

Noninvasive diagnosis continues to present a challenge in chronic bone infections. Positive intraoperative microbiological and/or histological results are regarded as the gold standard for confirmation of the diagnosis. The aim of the present study was to evaluate the value of F-18 FDG-PET in the diagnosis of chronic osteitis in the patients of a department devoted specifically to septic orthopaedic surgery. In particular, the study was intended to answer the question of whether the results of FDG-PET correlate with those found in intraoperatively removed biopsy specimens (microbiology, histology) and what value this method of investigation has relative to computed tomography (CT) and magnetic resonance imaging (MRI).

Methods

An F-18 FDG-PET examination was performed preoperatively in each of 50 patients with a suspected diagnosis of „chronic osteitis of bone/s in a limb“. All these patients had a history of an open fracture and/or a previous operation on the affected limb. The FDG-PET results were analysed blind. All patients enrolled in the study were subsequently operated on. After surgery, the results of histological and microbiological examination of the biopsy specimens taken intraoperatively were compared with the results of the FDG-PET and of CT (n=22) and MRI (n=18). Finally, the sensitivity, specificity and accuracy of each method were determined.

Results

Postoperatively the biopsy specimens from 37 patients yielded positive results in the microbiological and/or histological tests. According to this gold standard, then, osteitis was not present in 13 patients. In the preoperative FDG-PET report 34 of the patients whose microbiological and/or histological results were positive were correctly diagnosed as infection positive. In addition, 4 false-positive results were observed. False-negative results were recorded in 3 patients and true-negative results, in 9. The sensitivity and specificity were 92% and 69%, respectively, for the entire group of patients. The accuracy was 86%. The sensitivity, specificity and accuracy were 47%, 60% and 50%, respectively, for CT and 82%, 43% and 67%, respectively, for MRI.

Conclusion

F-18 FDG-PET is a promising diagnostic imaging method with high sensitivity and accuracy in the investigation of chronic osteitis. If the result of FDG-PET is negative chronic osteitis can be virtually excluded. The results presented suggest that it is superior to CT and MRI in sensitivity and accuracy. A definitive diagnosis of chronic osteitis will continue to require an invasive method in the future, in the form of removal of biopsy specimens for microbiological and histological tests.

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Authors and Affiliations

  1. BG Unfallklinik Murnau, Murnau, Deutschland

    M. Goebel, A. Grillhoesl, G.O. Hofmann &  M.H. Kirschner

  2. Zentrum für Orthopädie, Sportorthopädie und Unfallchirurgie, Städtische Kliniken GmbH, München, Deutschland

    M. Goebel

  3. Klinik und Poliklinik für Nuklearmedizin, Klinikum Großhadern, LMU München, München, Deutschland

    F. Rosa & K. Tatsch

  4. Klinik für Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland

    A. Grillhoesl

  5. BG Unfallklinik Bergmannstrost, Halle, Deutschland

    G.O. Hofmann

  6. Klinik für Unfall-, Hand- u. Wiederherstellungschirurgie, Friedrich-Schiller-Universität Jena, Jena, Deutschland

    G.O. Hofmann

  7. Stabsabteilung Medizinische Wissenschaft, B. Braun Melsungen AG, Stadtwaldpark 10, 34212, Melsungen, Deutschland

    M.H. Kirschner

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  1. M. Goebel
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Goebel, M., Rosa, F., Tatsch, K. et al. Diagnostik der chronischen Osteitis des Extremitätenskeletts. Unfallchirurg 110, 859–866 (2007). https://doi.org/10.1007/s00113-007-1302-y

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