99Tcm-MDP SPECT/CT骨显像在绝经后女性骨质疏松性胸腰椎椎体骨折中的增益价值

目的研究99Tcm-MDP SPECT/CT骨显像及其半定量分析指标在绝经后女性骨质疏松性胸腰椎椎体骨折中的增益价值。 方法回顾性分析2012年11月至2016年10月因轻微外伤或日常活动导致胸腰背部疼痛而就诊，最终诊断为骨质疏松性胸腰椎椎体压缩性骨折的绝经后女性患者81例。选取SPECT/CT矢状位融合断层图像，利用ROI技术重复勾画病灶椎体（T）及与其相邻的正常椎体（NT），并计算病灶椎体与正常椎体的放射性计数比值，即T/NT值。将所收集病例根据椎体是否在99Tcm-MDP SPECT/CT骨显像后进行手术分成两组，一组为手术组，包括行经皮穿刺椎体成形术及椎体球囊后凸成形术的患者，另一组为非手术组。对两组T/NT值采用两独立样本t检验进行统计学分析。 结果（1）手术组共计110个椎体，T/NT值为2.44±0.84；非手术组共计70个椎体，T/NT值为1.04±0.14，两组T/NT值的差异有统计学意义（t=13.654，P < 0.05）。（2）发现椎体以外骨折，包括肋骨骨折29例、椎体附件骨折2例、骶骨骨折2例、耻骨骨折1例。 结论99Tcm-MDP SPECT/CT骨显像及其半定量分析指标在指导绝经后女性骨质疏松性胸腰椎椎体压缩性骨折临床治疗方案的选择和其他部位是否有骨折的诊断中具有一定的参考价值。

Incremental values of 99Tcm-MDP bone scan in postmenopausal women with osteoporotic thoracolumbar vertebral fractures

Objective To assess incremental values of 99Tcm-MDP SPECT/CT bone scan imaging by semi-quantitative analysis indexes for osteoporotic thoracolumbar vertebral fractures in postmenopausal women.Methods This retrospective study enrolled 81 postmenopausal women patients diagnosed and treated for back pain from November 2012 to October 2016.All patients were diagnosed with osteoporotic thoracolumbar vertebral compression fractures.All patients underwent 99Tcm-MDP SPECT/CT bone imaging,and techniques for ROI were repeatedly applied to draw sagittal imaging sites of regional uptake in ROI,to record the number of radioactive counting of lesions (T) and adjacent normal vertebral sagittal imaging (NT),and to calculate T/NT ratio.Patients were divided into two groups.One group was treated by vertebroplasty or kyphoplasty after 99Tcm-MDP SPECT/CT bone imaging,and the other was treated with conservative treatment.T/NT ratios of the two groups were statistically analyzed.Results A total of 110 vertebral fractures were treated by vertebroplasty or kyphoplasty after 99Tcm-MDP SPECT/CT bone imaging,and 70 vertebral fractures were treated with conservative treatment.T/NT ratio of fractures reached 2.44±0.84 and 1.04±0.14,respectively (t=13.654,P＜0.05),after treatment with vertebroplasty or kyphoplasty;and conservative treatment.Some concurrent lesions which were absent in X-ray or MRI were detected by SPECT/CT,for example,29 rib fractures and 2 sacrum fractures.Conclusion 99Tcm-MDP SPECT/CT bone imaging by semi-quantitative analysis can effectively guide treatment of vertebral compression fractures.