^(99m)Tc-MDP SPECT/CT和1.5T MRI诊断骨质疏松椎体新鲜骨折的比较研究

^(99m)Tc-MDP SPECT/CT versus 1.5T MRI in the diagnosis of osteoporotic fresh vertebral compression fractures:a comparative study

目的探讨^(99m)Tc-MDP SPECT/CT融合显像对骨质疏松性椎体压缩骨折(OVCFs)患者经皮椎体成形术(PVP)术前新鲜骨折椎体的检出情况,从而指导PVP的治疗。方法回顾性收集2020年7月至2023年2月在遂宁市中心医院临床诊断为老年性OVCFs的患者,根据纳入、排除标准,最终纳入43例研究对象,共涉及95节椎体(新鲜性OVCFs 61节,陈旧性VCFs 34节)。所有研究对象均做了^(99m)Tc-MDP SPECT/CT融合显像和MRI两种影像检查,结合患者临床表现、病史、体征、实验室检查、影像学诊断以及PVP术后VAS和ODI评分是否减轻,综合判断两种影像检查对新鲜性OVCFs定位的准确性。结果43例患者术前VAS和ODI评分分别为(8.02±1.10)和(69.92±7.95),术后1、3 dVAS评分分别为(4.00±1.09)、(1.86±1.08),术后1个月ODI评分为(35.30±7.10),术后VAS和ODI评分较术前显著降低,且术后VAS评分逐步递减(P<0.05)。^(99m)Tc-MDP SPECT/CT融合显像最终诊断新鲜性OVCFs 58节,陈旧性VCFs 37节,检出新鲜性OVCFs情况与最终行PVP手术椎体符合57节;MRI检查最终诊断新鲜性OVCFs 60节,陈旧性VCFs 35节,检出新鲜性OVCFs情况与最终行PVP手术椎体符合60节,两种影像检查对新鲜性OVCFs检出的敏感度、特异度及准确度差异无统计学意义(P>0.05),^(99m)Tc-MDP SPECT/CT和MRI诊断新鲜性OVCFs的ROC曲线下面积分别为0.953和0.992。结论对于OVCFs,^(99m)Tc-MDP SPECT-CT融合显像能够准确诊断新鲜椎体骨折,在MRI检查不适用时可作为替代检查方法。

Objective To investigate the value of ^(99m)Tc-MDP SPECT/CT fusion imaging in detecting fresh vertebral body fractures in patients with osteoporotic vertebral compression fractures(OVCFs)before receiving percutaneous vertebroplasty(PVP),so as to provide reference for PVP operation.Methods The patients,who were diagnosed as senile OVCFs at the Suining Municipal Central Hospital of China between July 2020 and February 2023,were retrospectively collected.Based on the inclusion and exclusion criteria,a total of 43 patients(95 vertebrae in total,including 61 fresh vertebral compression fractures and 34 old vertebral compression fractures)were finally enrolled in this study.Both ^(99m)Tc-MDP SPECT/CT fusion imaging and MRI were performed in all patients.Combining the patient's clinical manifestations,medical history,signs,laboratory tests,imaging diagnosis,and post-PVP VAS score and Oswesty disability index(ODI),the accuracy of the localization of the fresh OVCFs by the two imaging examinations was comprehensively evaluated.Results In the 43 patients,the preoperative VAS score and ODI score were(8.02±1.10)points and(69.92±7.95)points respectively.The postoperative one-day and 3-day VAS scores were(4.00±1.09)points and(1.86±1.08)points respectively,and postoperative one-month ODI score was(35.30±7.10)points.Both postoperative VAS score and ODI score were significantly lower than their preoperative scores,and the postoperative VAS scores showed a progressively declining trend(P<0.05).^(99m)Tc-MDP SPECT/CT fusion imaging finally diagnosed 58 fresh OVCFs and 37 old VCFs,and up to 57 out of 58 fresh OVCFs were consistent with the PVP surgical results.MRI finally diagnosed 60 fresh OVCFs and 35 old VCFs,and 60 fresh OVCFs were consistent with the PVP surgical results.There were no statistically significant differences in the sensitivity,specificity and accuracy for the detection of fresh OVCFs between the two imaging methods(all P>0.05).The area of ROC of ^(99m)Tc-MDP SPECT/CT and MRI for the diagnosis of fresh vertebral compression fracture was 0.953 and 0.992 respectively.Conclusion For OVCFs,^(99m)Tc-MDP SPECT-CT can accurately diagnose fresh vertebral fractures,it can be used as an alternative examination method when MRI examination is not applicable.