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

English Keywords:Osteoporotic vertebral compression fractures  Single-photon emission computed tomography-computed tomography  Magnetic resonance imaging  Percutaneous kyphoplasty

English Abstract:

  【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.