X射线、MRI及SPECT/CT对全髋关节置换术后假体周围骨溶解的诊断效能比较

Efficacy comparison of X-ray, MRI, and SPECT/CT in diagnosis of periprosthetic osteolysis after total hip replacement

摘要:

目的 分析X射线、磁共振成像（MRI）及单光子发射计算机体层摄影（SPECT）/计算机体层成像（CT）对全髋关节置换术后假体周围骨溶解的诊断效能。方法 选取2016年8月—2020年8月苏州大学附属第二医院收治的90例全髋关节置换术后疑似假体周围骨溶解患者。所有患者均接受X射线、MRI及SPECT/CT检查。以翻修术结果为金标准，分析X射线、MRI及SPECT/CT对假体周围骨溶解的诊断效能。结果 翻修术结果显示，70例患者有假体周围骨溶解，其余20例患者中无菌性松动13例，感觉障碍4例，假体周围骨折3例。X射线、MRI、SPECT/CT及联合诊断假体周围骨溶解与金标准的一致性分别为0.585、0.686、0.842、0.906。SPECT/CT诊断的敏感性（95.71%）及准确性（94.44%）均高于X射线与MRI（P <0.05）；联合诊断的敏感性（98.57%）及准确性（97.78%）高于X射线与MRI（P <0.05）。4种诊断效能从高至低依次为联合诊断、SPECT/CT、MRI、X射线。结论 X射线、MRI及SPECT/CT对全髋关节置换术后假体周围骨溶解有一定的诊断效能，SPECT/CT的敏感性、准确性最高，联合诊断可提高诊断效能，临床可根据实际情况合理选择诊断方式。

Abstract:

Objective To analyze the diagnostic value of X-ray, magnetic resonance imaging (MRI), and single-photon emission computerized tomography (SPECT)/computed tomography (CT) in periprosthetic osteolysis after total hip arthroplasty.Methods From August 2016 to August 2020, 90 patients with suspected periprosthetic osteolysis after total hip replacement were selected from the Second Affiliated Hospital of Suzhou University. All patients were examined by X-ray, MRI, and SPECT/CT, and the gold standard was revision. The diagnostic efficacy of X-ray, MRI, and SPECT/CT in periprosthetic osteolysis was analyzed.Results A total of 70 patients had periprosthetic osteolysis, 13 had aseptic loosening, 4 had sensory disturbance, and 3 had periprosthetic fracture. The consistency with gold standard of X-ray, MRI, SPECT/CT, and combined diagnosis for periprosthetic osteolysis were 0.585, 0.686, 0.842, and 0.906, respectively. The sensitivity (95.71%) and the accuracy (94.44%) of SPECT/CT were higher than X-ray and MRI (P < 0.05), and the sensitivity (98.57%) and the accuracy (97.78%) of combined diagnosis was highe than X-ray and MRI (P < 0.05). The combined diagnosis had highest diagnosis efficacy, folled by SPECT/CT, MRI and X-ray.Conclusion X-ray, MRI, and SPECT / CT have certain diagnostic value for periprosthetic osteolysis after total hip replacement, but the diagnosis of SPECT / CT has the highest sensitivity and accuracy. The combined diagnosis can improve the diagnostic efficacy and can be reasonably selected according to the actual situation.