定量 99mTc-MDP SPECT/CT在老年骨质疏松性压缩骨折中的诊断价值

  目的  探讨定量单光子发射计算机断层扫描（SPECT）/CT获得的标准摄取值在老年骨质疏松性椎体压缩骨折的临床价值。  方法  回顾性分析2019年8月~2021年6月于我院就诊的65例骨质疏松性压缩骨折患者的临床资料。患者分别接受 99mTc-MDP 全身骨显像、局部SPECT/CT断层显像及磁共振成像。根据临床病史，将107个骨折椎体分为新鲜组（n=60）及陈旧组（n= 47），通过图像处理分析，分别计算两组椎体最大标准摄取值（SUV_max）以及平面图像和断层图像的靶区/非靶区比值（T/NT）并比较差异；绘制ROC曲线来获得SUV_max及T/NT的最佳临界值，并比较其诊断效能。  结果  新鲜组、陈旧组及正常组椎体SUV_max分别为43.20±17.17、10.71±3.17及9.78±2.95，新鲜组与陈旧组的差异有统计学意义（P < 0.01），而陈旧组与正常组的差异无统计学意义（P > 0.05）；平面显像T/NT分别为2.22±0.70及1.41±0.45，差异有统计学意义（P < 0.01）；断层显像T/NT分别为5.06±3.52及2.08±0.73，差异有统计学意义（P < 0.01）。通过绘制ROC曲线获得SUV_max、平面显像T/NT及断层显像T/NT的最佳临界值进行鉴别诊断，SUV_max的诊断敏感度、特异性、诊断一致性均高于平面显像T/NT及断层显像T/NT。  结论  定量SPECT/CT标准摄取值在老年骨质疏松性压缩骨折的诊断中具有重要的参考价值，为临床治疗提供客观依据。 

Value of quantitative 99mTc-MDP SPECT/CT in elderly osteoporotic spinal compression fractures

  Objective  To investigate the clinical value of standard uptake value obtained by quantitative single-photon-emission computed tomography (SPECT)/CT in elderly osteoporotic spinal compression fractures.  Methods  Sixty-five patients with osteoporotic compression fractures who underwent 99mTc-MDP whole body bone scan, SPECT/CT scan and magnetic resonance imaging(MRI) from August 2019 to June 2021 were enrolled. Based on the clinical history, 107 fractured vertebrae were divided into fresh group (n=60) and old group (n=47), the maximum standard uptake value (SUV_max) and the target/non-target ratio (T/NT) between the two groups was compared. Analyze the correlation between the SUV_max of the fractures and the injury time. ROC curves were plotted to obtain the cut-off values of SUV_max and T/NT and to compare their diagnostic value.  Results  The vertebral SUV_max was 43.20 ± 17.17, 10.71 ± 3.17 and 9.78 ± 2.95 in the fresh, old and normal groups, respectively, with significant differences between the fresh and old groups (P < 0.01) and no significant differences between the old and normal groups (P > 0.05). The planar T/NT was 2.22 ± 0.70 and 1.41 ± 0.45 in the fresh and old groups, the difference was statistically significant (P < 0.01). The tomo T/NT was 5.06±3.52 and 2.08±0.73 in the fresh and old groups, the difference was statistically significant (P < 0.01). The cut-off values of SUV_max, planar T/NT and tomo T/NT were obtained by plotting ROC curves for differential diagnosis, and the diagnostic sensitivity, specificity and diagnostic agreement of SUV_max were higher than planar T/ NT and tomo T/NT.  Conclusion  The standard uptake value of quantitative SPECT/CT has important reference value in the diagnosis of elderly osteoporotic spinal compression fractures, it can provide an objective basis for clinical treatment.