SPECT-CT与MRI对确定骨质疏松性椎体压缩骨折疼痛责任椎体的价值比较

SPECT/CT versus MRI in localizing pain site in patients with osteoporotic vertebral compression fractures

中文关键词:  骨质疏松椎体压缩骨折  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  椎体后凸成形术

英文关键词:Osteoporotic vertebral compression fractures  Single-photon emission computed tomography-computed tomography  Magnetic resonance imaging  Percutaneous kyphoplasty

中文摘要:

  【摘要】 目的：探讨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（single photon emission computed tomography-computed tomography，SPECT-CT）与磁共振成像（MRI）在确定骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures，OVCFs）疼痛责任椎体的一致性。方法：选取2015年12月~2016年12月期间吉林大学中日联谊医院46例OVCFs患者，其中28例患者病程在3周之内，属于急性期骨折；18例病程在3周以上，属于非急性骨折。患者均行SPECT-CT和MRI检查，根据MRI及SPECT-CT共同确定疼痛责任椎体，行PKP术，采用疼痛视觉模拟评分法（visual analogue score，VAS）评估手术治疗效果，使用配对样本t检验分析治疗前后VAS评分，从而判定责任椎体的准确性，应用Kappa检验和McNemar检验分析两种检查法的一致性和差异性，并计算SPECT-CT诊断的准确性指标。结果：46例患者中，MRI检查出OVCFs的责任节段79个，SPECT-CT检查出责任节段83个，最终77个椎体行PKP手术治疗。术前VAS评分8.33±2.12分，术后3天评分0.89±1.86分，术后1个月评分0.30±0.94分，较术前明显改善（P＜0.05）。急性期28例患者共36个椎体行PKP手术治疗，MRI检查符合诊断标准的37个节段，SPECT-CT检查36个节段。非急性期18例患者共41个椎体行PKP手术治疗，MRI检查出42个节段，SPECT-CT检查出47个节段。分别将骨折不同时期的MRI和SPECT-CT的诊断结果进行Kappa检验，结果提示结果提示急性期两种检查方法高度一致（Kappa=0.943，P＜0.05），非急性期一致性一般（Kappa=0.734，P＜0.05）。对比不同时期骨折的SPECT-CT与MRI检查结果的符合性采用McNemar检验，结果提示两种检验方法之间的差异不具有统计学意义（P>0.05）。此外，骨折的不同时期尤其是急性期，SPECT-CT与MRI的诊断性试验指标一致性较高。结论：SPECT-CT在骨质疏松性椎体压缩骨折的定位、定性上与MRI具有较高的一致性，尤其对于急性期骨折的患者，其具有较好的临床应用价值。

英文摘要:

  【Abstract】 Objectives: To evaluate the difference and consistency between single-photon emission computed tomography-computed tomography(SPECT-CT) and magnetic resonance imaging(MRI) in diagnosing osteoporotic vertebral compression fractures(OVCFs) and identifying active lesions. Methods: Forty-six patients with OVCFs who underwent both SPECT-CT and MRI from December 2015 to December 2016 were included in this study. The disease course was within three weeks for 28 patients (belonging to acute fractures), and more than three weeks for 18 patients (belonging to non-acute fractures). All patients underwent SPECT-CT and MRI examination, and the pain vertebral body and pain sites were determined by both MRI and SPECT-CT for the PKP surgery. Differences before and after treatment were assessed by using VAS scores and evaluated by paired t-test with 95% confidence interval(CI). The number of fresh OVCFs diagnosed by MRI and SPECT-CT in different stages of fracture was tested by using the Kappa statistic with a CI of 95%. In addition, the conformity of SPECT-CT and MRI was determined by using the McNemar test with a CI of 95%. Results: Among all 46 patients, MRI found 79 segments that met the diagnostic criteria for fresh OVCFs, and SPECT-CT found 83 segments, and a total of 77 affected vertebral bodies were treated with PKP. The VAS score at preoperation, postoperative three days and postoperative one month was 8.33±2.12, 0.89±1.86 and 0.30±0.94 respectively. Results revealed that PKP surgery was effective, which suggested that the affected sites were accurately determined(P<0.05). In addition, a total of 36 affected vertebral bodies were treated with PKP in 28 patients with acute fractures. MRI diagnosed 37 segments and SPECT-CT diagnosed 36 segments. A total of 41 affected vertebral bodies were treated with PKP in 18 patients with non-acute fractures. MRI diagnosed 42 segments and SPECT-CT diagnosed 47 segments. The number of fresh OVCFs diagnosed by MRI and SPECT-CT in different fracture stages was tested by kappa statistics, which revealed that these two methods were highly consistent in acute (Kappa=0.943, P＜0.05) and generally consistent in no-acute(Kappa=0.734, P＜0.05). The conformity between SPECT-CT and MRI was analyzed by using the McNemar test, which revealed that the difference was not statistically significant, indicating that the efficacy of these two diagnostic methods was closely correlated(P>0.05). In different stages of fractures, especially acute phase, the consistency of SPECT-CT and MRI in the diagnosis of fresh OVCFs was high. Conclusions: The location determined by SPECT-CT in OVCFs was qualitatively consistent with MRI, and especially for patients with acute fractures, SPECT-CT has good clinical value.