【摘要】 目的:评价氟代脱氧葡萄糖(FDG)正电子发射计算机断层显像(PET/CT)对心脏术后慢性胸骨正中切口感染的定性、定位诊断价值,以及对手术清创的引导价值。方法:选择2015年2月—2015年12月在复旦大学附属中山医院整形外科诊治的21例心脏外科手术后慢性胸骨正中切口感染的患者。21例患者均在术前1周行PET/CT检查。根据PET/CT及CT影像对21例患者的胸骨感染范围、是否存在肋软骨炎及感染肋软骨的位置进行判断,并与术中诊断结果进行比较,评价PET/CT对慢性胸骨正中切口感染的定性及定位诊断价值。根据PET/CT结果,引导手术清创,术后随访6~16个月,评价慢性胸骨正中切口感染的清创重建手术效果。结果:21例慢性胸骨正中切口感染患者中,20例为胸骨骨髓炎、18例为纵隔感染、9例为肋软骨炎。PET/CT诊断胸骨正中切口感染的准确性均为100%。PET/CT对肋软骨炎定位诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为85.71%、99.74%、96.00%、98.99%、98.81%,其中敏感度、阴性预测值及准确度均优于CT(P值分别为0.002、0.008、0.01)。慢性胸骨正中切口感染患者PET/CT引导下1次清创重建术后的治愈率为85.7%。结论:PET/CT对心脏术后慢性胸骨正中切口感染的定位及定性诊断准确,效果显著优于CT,可用于引导手术清创。更多还原

【Abstract】 Objective:To evaluate the qualitative and localization diagnostic value of PET/CT in chronic sternal median incision infection after heart surgery and the guiding function of PET/CT image in debridement.Methods:Twenty-one patients with chronic sternal median incision infection admitted to our hospital from February 2015 to December 2015 underwent PET/CT examinations within one week prior to surgery were selected.Detection of extent of sternal wound infection and localization diagnoses of costal chondritis were conducted by using PET/CT and CT,and the results were compared with the diagnosis results during surgery.The qualitative and localization diagnostic value of PET/CT in chronic sternal median incision infection were evaluated.Debridement was guided by the PET/CT images.Patients were followed up for 6-16 months after operation,and the debridement and reconstructive surgery effect on chronic sternal median incision infection was evaluated.Results:There were 20 cases of sternal osteomyelitis,18 cases of mediastinitis,and 9 cases of costal chondritis.Accuracies of PET/CT in above diagnoses were all 100%.Sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of PET/CT in localizing involved costal cartilages were 85.71%,99.74%,96.00%,98.99%,and 98.81%,respectively.Sensitivity,negative predictive value,and accuracy of PET/CT in localizing involved costal cartilages were significantly higher than those of CT(Pvalues were 0.002,0.008,and 0.01).Cure rate of patients with costal chondritis after first debridement operation was 85.7%.Conclusions:PET/CT is of high accuracy in qualitative diagnosis and localization compared with CT in chronic sternal median incision infection after heart surgery,which is promising in guidance of debridement operation.更多还原