SPECT-CT图像融合技术对老年椎体压缩骨折患者选择椎体强化术靶椎体的应用价值

The value of SPECT-CT fusion image in selection of target vertebrae for percutaneous vertebral augmentation for the aged patients of vertebral compression fracture

中文关键词:  椎体压缩骨折  单光子发射计算机断层摄像联合同机CT扫描  椎体强化术  靶椎体

英文关键词:Vertebral compression fracture  Single photon emission computed tomography and computer tomography  Fusion image  Percutaneous vertebrae augmentation  Target vertebrae

中文摘要:

  【摘要】 目的：探讨单光子发射计算机断层摄像联合同机CT扫描（single photon emission computed tomography and computer tomography，SPECT-CT）图像融合技术对老年椎体压缩骨折患者选择椎体强化术靶椎体的应用价值。方法：2010年6月~2011年4月对4例因体内置入顺磁性材料而不能接受MRI的老年椎体压缩骨折患者应用Infinia Hawkeye 4图像融合系统行SPECT全身平面骨显像，然后对感兴趣区病灶行同机CT检查，用图像融合软件完成SPECT-CT图像融合，在SPECT-CT融合图像上出现核素浓集的椎体考虑为病椎，在同机CT重建图像上仔细分析病椎CT图像、排除肿瘤或感染性骨破坏可能，从而确立骨质疏松性椎体压缩骨折的临床诊断，并定位椎体强化术靶椎体。男1例，女3例；年龄59～79岁，平均67.4岁；病程8d～2个月，平均17d；因冠心病安装冠状动脉金属支架2例、心脏起搏器1例，体内置入不锈钢股骨头假体1例；诊断确立后实施椎体强化术，记录术前、术后2d的VAS和Oswestry功能障碍指数（ODI）以评估手术疗效，放射学检查随访以进一步证实SPECT-CT图像融合检查的准确性。结果：SPECT-CT融合图像中，3例患者单个椎体、1例2个椎体出现核素浓集，其中T12 2例、L1 1例、L2 1例、L3 1例，同机CT重建图像提示病变椎体中无肿瘤或感染性骨破坏征象。术前、术后2d VAS分别为8~9分、1.5~2.5分，术前、术后2d ODI分别为80%~90%、20%~30%，术后2d与术前相比改善明显。随访8~13个月，平均10个月，影像学随访病椎未出现迟发性骨破坏。结论：对于不能接受MRI检查的老年椎体压缩骨折患者，SPECT-CT图像融合技术可清楚定位核素浓集区的病变节段，通过分析核素浓集区骨结构特点可确定疾病性质；SPECT-CT图像融合技术在选择椎体强化术靶椎体上有一定实用价值。

英文摘要:

  【Abstract】 Objectives: To analyze the value of single photon emission computed tomography and computer tomography（SPECT-CT） fusion image in selection of target vertebrae for percutaneous vertebral augmentation for the aged patients of vertebral compression fracture. Methods: 4 elderly cases suffering from vertebral compression fracture from June 2010 to April 2011 were reviewed retrospectively, all cases were not suitable for MRI due to paramagnetic metal instrument in their bodies previously. The SPECT-CT fusion image was used as alternative to MRI. The whole skeletal image of SPECT was performed by Infinia Hawkeye 4 machine, then CT scan was performed to evaluate the area of interest by the same machine and the fusion image of SPECT and CT was finished by fusion image software. The lesion vertebrae were determined based on the area of nuclide accumulation in the whole skeletal image of SPECT, then the clinical diagnosis of osteoporosis vertebral compression fracture(OVCF) was confirmed by excluding the probability of neoplasm or infection after analyzing the CT image of local bone lesion, and the target vertebrae for percutaneous vertebral augmentation were located clearly by SPECT-CT fusion image. There were 1 male and 3 females, with the mean age of 67.4 years(59-79 years) and mean duration of 17 days(8-60 days). All cases were not suitable for MRI due to implanted paramagnetic metal instrument including coronary artery metal stent in 2 cases, heart metal pacemaker in 1 case and artificial femur head made of stainless steel in 1 case. The clinical outcomes were evaluated by visual analog scale(VAS) and Oswestry disability index(ODI) at preoperation and 2 days after operation. All cases accepted radiographic examination in follow-up to exclude the spinal neoplasm and in?鄄fection. Results: Based on the SPECT-CT fusion image, nuclide accumulation was found in 1 segment of 3 cases, 2 segments of 1 case. The lesions included T12 in 2 cases, L1 in 1 case, L2 in 1 case and L3 in 1 case. No spinal neoplasm and infection were noted in CT scan. The VAS scores and ODI in baseline was 8-9 and 80%-90% at preoperation respectively; while 1.5-2.5 and 20%-30% for 2 days after operation, which showed significant improvement. During the average follow-up of 10 months, spinal neoplasm and infection were not noted. Conclusions: For the aged patients of vertebral compression fracture who are unsuitable for accepting MRI examination, SPECT-CT fusion image can be used to locate clearly the lesion vertebrae and determine the clinical diagnosis of OVCF by analyzing the bone structure in the area of nuclide collection; SPECT-CT fusion image is useful for selection of the target vertebrae for percutaneous vertebral augmentation.