Uloga trofazne scintigrafije kostiju sa 99mTc-MDP u dijagnozi periprotetske infekcije kuka i kolena

  • Dragan M Pucar Institute of nuclear medicine, Military Medical Academy, Belgrade
  • Zoran Janković Military Medical Academy, Institute of Nuclear Medicine, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Zoran Baščarević University of Belgrade, Faculty of Medicine, Institute for Orthopedic Surgery “Banjica”, Belgrade, Serbia
  • Srdjan Starčević Military Medical Academy, Clinic for Orthopedic Surgery and Traumatology, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Milica Čizmić Military Medical Academy, Clinic for Endocrinology, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Marija Radulović Military Medical Academy, *Institute of Nuclear Medicine, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP160303152P
Ključne reči: hip prosthesis||, ||kuk, proteza, knee prosthesis||, ||koleno, infection||, ||infekcija, diagnosis||, ||dijagnoza, sensitivity and specificity||, ||senzitivnost i specifičnost, technetium tc99m medronate||, ||tehnecijum tc99m medronat,

Sažetak


Uvod/Cilj. U poslednjih pet decenija primarna artroplastika kuka i kolena predstavlja jednu od najčešćih i najefikasnijih hirurških intervencija širom sveta. Infekcija, iako retka, jeste najozbiljnija komplikacija. Nuklearno medicinsko snimanje, koje nije ometeno metalnim hardverom proteskog zgloba, je trenutno modalitet izbora za procenu sumnje na periprotetsku infekciju zgloba. Cilj ovog istraživanja bio je da se proceni dijagnostička tačnost trofazne 99m technetium methylene diphosphonate (99mTc-MDP) scintigrafije kostiju kod periprotetske infekcije kuka i kolena. Metode. Kriterijumi za uključivanje bolesnika u studiju bili su postojanje sumnje na periprotetsku infekciju zgloba kuka i kolena. U ovoj studiji smo ispitivali 45 bolesnika (14 muškaraca i 31 žene) sa 39 implanta kuka i 24 proteze kolena (ukupno 63). Kod svih bolesnika bila je urađena trofazna scintigrafija skeleta nakon intravenske aplikacije 555 MBq 99mTc-MDP. Konačna potvrda infekcije ustanovljena je bio mikrobiološkim ili patohistološkim nalazom. Rezultati. Infekcija je bila potvrđena kod 29 protetskih zglobova, 13 (44,8%) kolena i 16 (55,2%) kuka, a isključena kod 34 protetska zgloba. Povezanost različitih modaliteta negativnih i pozitivnih nalaza 99mTc-MDP trofazne scintigrafije kostiju sa konačnom potvrdom infekcije pokazuje visoku statističku značajnost (p < 0,001). Trofazna scintigrafija skeleta pokazala je visoku osetljivost od 90%, ali skromnu specifičnost od 69,7% u otkrivanju periprotetske infekcije, dok je dijagnostička tačnost bila 79%. Izračunata pozitivna prediktivna vrednost za metodu iznosila je 73%, ali negativna prediktivna vrednost bila je visoka (89%). Naši rezultati trofazne scintigrafije skeleta sa vrednostima osetljivosti od 90%, specifičnosti od 69,7% i dijagnostičke tačnosti od 79% u saglasnosti su sa većinom objavljenih studija, pa i diskretno bolji. Zaključak. Scintigrafija skeleta je osetljiva metoda u dijagnostici periprotetske infekcije, ali je nedovoljno specifična. U otkrivanju periprotetske infekcije, trofazna scintigrafija kostiju može se koristiti kao dijagnostička metoda prve linije samo u cilju njenog isključivanja. Jedino razumno korišćenje scintigrafije kostiju je u kombinaciji sa drugim radionuklidnim metodama visoke specifičnosti.

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Objavljeno
2017/10/27
Broj časopisa
Vol. 74 Br. 10 (2017)
Rubrika
Originalni članak