SPECT、SPECT-CT与MRI对新鲜骨质疏松性椎体压缩骨折的诊断价值

The value of SPECT, SPECT-CT and MRI in the diagnosis of fresh osteoporotic vertebral compressive fracture

中文关键词:  椎体压缩骨折  单光子发射计算机断层摄影术  单光子发射计算机断层摄影术联合同机CT扫描图像融合技术  磁共振成像  骨质疏松

英文关键词:Osteoporosis vertebral compressive fracture  Single photon emission computed tomography  Single photon emission computed tomography and computer tomography  Magnetic resonance imaging

中文摘要:

  摘要】 目的：比较分析单光子发射计算机断层摄影术（SPECT）、单光子发射计算机断层摄影术联合同机CT扫描图像融合技术（SPECT-CT）与磁共振成像（MRI）对新鲜骨质疏松性椎体压缩骨折（OVCF）的诊断价值。方法：对2011年10月~2012年4月因OVCF就诊而又同时接受了胸腰椎MRI、SPECT及SPECT-CT检查的20例老年患者进行回顾性分析，其中女12例，男8例，年龄60~80岁，平均73.5岁，平均病程21d。根据MRI表现确定最终诊断，MRI上出现骨髓水肿像的椎体定义为新鲜骨折椎体，椎体形态有压缩改变但MRI信号无异常者定义为陈旧骨折。由2位核医学医师分别评估SPECT及SPECT-CT检查，记录出现核素浓集的椎体，并给出疾病诊断意见。采用Kappa检验对比MRI与SPECT-CT判断新鲜骨折及陈旧骨折的一致性以及定性诊断能力。参考MRI发现，采用卡方检验分析SPECT与SPECT-CT定位病椎能力的异同。结果：根据MRI或SPECT-CT，20例患者均确诊为新鲜OVCF，其中MRI发现32个椎体存在新鲜OVCF，SPECT-CT发现34个椎体存在新鲜OVCF；根据SPECT诊断新鲜OVCF 12例，疑似新鲜OVCF但难以与肿瘤、感染相鉴别8例，共发现34个椎体存在核素浓集。MRI发现新鲜OVCF 32个椎体、陈旧OVCF 10个椎体，SPECT-CT发现新鲜OVCF 34个椎体、陈旧OVCF 8个椎体，两者之间具有良好的一致性（Kappa=0.0577，P<0.05）。在对病椎定位的准确性上，以MRI定位的病椎节段为参考，SPECT与MRI定位相同24个椎体，SPECT-CT与MRI定位相同30个椎体，SPECT-CT定位准确性优于SPECT（P<0.05）。SPECT-CT检查还发现了MRI未能显示的骨骼病损，其中骶尾椎骨折1例，肋骨骨折2例，骶髂关节炎1例，胸锁关节良性病变1例。结论：SPECT-CT在OVCF的定位、定性诊断上与MRI的价值相似，其准确定位病椎的性能优于传统SPECT检查；SPECT-CT还可以发现一些MRI未能显示的合并骨骼病损。SPECT-CT是患者不能接受MRI时的可靠选择。

英文摘要:

  【Abstract】 Objectives: To explore the values of single photon emission computed tomography(SPECT), single photon emission computed tomography and computer tomography(SPECT-CT) and magnetic resonance imaging(MRI) in the diagnosis of fresh osteoporotic vertebral compressive fracture(OVCF). Methods: Between October 2011 and April 2012, 20 elder patients suffering from vertebral compressive fracture and undergoing MRI, SPECT, SPECT-CT were analyzed retrospectively. There were 12 females and 8 males, with an average age of 73.5 years(60-80 years), and their average disease duration was 21 days. The diagnosis was based on MRI findings, with bone marrow edema defined as fresh OVCF, and the compressed vertebra without bone marrow edema was defined as old OVCF. Then SPECT bone imaging and hybrid SPECT-CT were performed respectively by 2 independent nuclear physicians to determine the specific level and diagnosis based on nuclear accumulation. The consistency about the ability of between SPECT-CT and MRI in discriminating fresh or old OVCF was analyzed by Kappa test. According to the findings of MRI, the ability of SPECT-CT and SPECT was compared between by Chi-square test. Results: Based on MRI or SPECT-CT, all patients were diagnosed as fresh OVCF, which included 32 levels in MRI and 34 in SPECT-CT, while for SPECT, only 12 patients were diagnosed as fresh OVCF, the others were suspected as fresh OVCF, but tumor or infection could not be excluded. 32 fresh OVCF and 10 old OVCF were found by MRI, and 34 fresh OVCF and 8 old OVCF were found by SPECT-CT, there was good consistency between them(Kappa=0.0577, P<0.05). As for the accuracy of locating lesion determined by MRI, 24 segments in SPECT and 30 segments in SPECT-CT were in accordance with the findings of MRI respectively, SPECT-CT had higher accuracy than SPECT(24 VS 30, P<0.05). Additionally, some concurrent bone lesions including sacral coccygeal vertebral fracture(1 case), rib fractures(2 cases), the inflammation of sacroiliac articulation(1 case) and benign lesion in sterno-clavicular articulation(1 case), which were absent in MRI were found by SPECT and SPECT-CT. Conclusions: SPECT-CT has the similar ability in diagnosing the fresh OVCF as MRI and has better accuracy of localizing lesion than traditional SPECT. Some other concurrent lesions which are absent in MRI can be found by SPECT-CT. Conclusively, SPECT-CT is a reliable alternative when MRI is unsuitable.