Purpose

Diagnosis of spinal infection (SI) is challenging and usually requires multiple tests. We aimed to perform a systematic review and a bivariate meta-analysis on the diagnostic role of ¹⁸F-FDG PET/CT in patients with SI.

Methods

A comprehensive literature search of studies published through February 2019 in PubMed/MEDLINE and Cochrane library databases was carried out. Studies investigating the diagnostic performance of ¹⁸F-FDG PET/CT in patients with SI were eligible for inclusion in the qualitative analysis. For the quantitative analysis, pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR−) and diagnostic odds ratio (DOR) of ¹⁸F-FDG PET/CT in patients with suspected SI were calculated on a per examination-based analysis. Pooled data were presented with 95% confidence intervals (95% CI).

Results

Twenty-six articles (833 patients) using ¹⁸F-FDG PET/CT were eligible for the qualitative analysis. Twelve studies (396 patients) were selected for the meta-analysis. Overall, ¹⁸F-FDG PET/CT demonstrated a very good diagnostic performance in patients with SI and several studies underlined the value of ¹⁸F-FDG PET/CT in assessing the response to treatment. The bivariate meta-analysis on ¹⁸F-FDG PET/CT in patients with suspected SI provided the following results: sensitivity 94.8% (95% CI 88.9–97.6%) and specificity 91.4% (95% CI 78.2–96.9%). The pooled LR+, LR− and DOR were 4.7 (95% CI 2.9–7.7), 0.11 (95% CI 0.07–0.16) and 63.4 (95% CI 28.9–139), respectively. No significant heterogeneity or publication bias was found.

Conclusion

¹⁸F-FDG PET/CT demonstrated a very good diagnostic performance in patients with SI and can be used in patients in which MRI cannot be performed or is non-diagnostic or inconclusive. Several studies underlined the value of ¹⁸F-FDG PET/CT in assessing the response to treatment in patients with SI. Overall, larger multicentre and prospective studies and cost-effectiveness analyses are warranted.

中文翻译：

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18 F-FDG PET / CT在脊柱感染患者中的诊断性能：系统评价和双变量荟萃分析

目的

脊柱感染（SI）的诊断具有挑战性，通常需要进行多次测试。我们旨在对¹⁸ F-FDG PET / CT在SI患者中的诊断作用进行系统的回顾和双因素荟萃分析。

方法

对截至2019年2月在PubMed / MEDLINE和Cochrane图书馆数据库中发表的研究进行了全面的文献检索。研究¹⁸ F-FDG PET / CT对SI患者诊断性能的研究符合定性分析的条件。为了进行定量分析，基于每次检查的分析计算了疑似SI患者中¹⁸ F-FDG PET / CT的合并敏感性，特异性，阳性和阴性似然比（LR +和LR-）和诊断比值比（DOR）。。汇总数据以95％的置信区间（95％CI）呈现。

结果

使用^18个F-FDG PET / CT的26篇文章（833例）符合定性分析的条件。选择十二项研究（396名患者）进行荟萃分析。总体而言，¹⁸ F-FDG PET / CT对SI患者表现出非常好的诊断性能，多项研究强调¹⁸ F-FDG PET / CT在评估治疗反应方面的价值。对疑似SI的患者进行的¹⁸ F-FDG PET / CT的双变量荟萃分析提供了以下结果：敏感性94.8％（95％CI 88.9–97.6％）和特异性91.4％（95％CI 78.2–96.9％）。合并的LR +，LR-和DOR分别为4.7（95％CI 2.9-7.7），0.11（95％CI 0.07-0.16）和63.4（95％CI 28.9-139）。没有发现明显的异质性或出版偏见。

结论

¹⁸ F-FDG PET / CT对SI患者表现出非常好的诊断性能，可用于无法进行MRI或无法诊断或不确定的MRI患者。几项研究强调了¹⁸ F-FDG PET / CT在评估SI患者对治疗的反应中的价值。总体而言，有必要进行更大范围的多中心和前瞻性研究以及成本效益分析。