^(99m)Tc-MDP SPECT/CT定量骨显像测定腰椎标准化摄取值的分析及应用

Analysis and application of standardized uptake value of the lumbar spine obtained from^(99m)Tc-MDP SPECT/CT quantitative bone imaging

目的探讨正常腰椎^(99m)Tc-MDP SPECT/CT显像标准化摄取值(SUV)测量的稳定性、分布情况及影响因素,及其在骨密度评估中的价值。方法回顾性分析2021年5月至2023年6月行^(99m)Tc-MDP腰椎SPECT/CT显像、并于SPECT/CT显像前后1月内行DXA骨密度测定的103例[男13例、女90例;年龄(54.86±7.84)岁]患者的基本资料,测量其正常腰椎SUVmax、SUVmean、CT值及BMD;采用Bland Altman检验及Pearson相关分析不同测量者间腰椎SUV的一致性及相关性,Pearson相关分析腰椎SUV、BMD、CT值与不同指标的相关性,单因素方差分析比较不同BMD患者组间不同指标的差异,组间两两比较用LSD检验。结果不同观察者测量SUVmax、SUVmean一致性好(分别有1.3%、3.3%个点位于95%一致性界限外),相关性高(r分别为0.985,0.850;P均<0.001)。测得502个腰椎SUVmax、SUVmean分别为7.91±2.26、4.70±1.40;腰椎SUVmax、SUVmean分布趋势为L_(1)~L_(3)逐渐增高,L_(3)最高,其次为L_(5),L_(4)次之。全部患者腰椎SUVmax、SUVmean与年龄负相关(P<0.05),与体质量(P分别<0.001、0.05)、BMI(P<0.001)、CT值(P<0.05)正相关,与身高不相关;83例行同期骨密度患者L_(1)-L_(4)椎体SUVmax、SUVmean与BMD(P<0.05)正相关;全部腰椎BMD与年龄负相关(P<0.05),与CT值正相关(P<0.001);CT值与年龄负相关(P<0.001)。不同骨量患者组间SUVmax、SUVmean、BMD、CT值差异具有统计学意义(P均<0.001)。结论SPECT/CT定量骨显像测定SUV操作便捷,稳定性好;临床应用腰椎SUV可综合考虑其分布趋势及影响因素;基于SUV测定的SPECT/CT显像在骨密度评估中具有较高的价值。

Objective To explore the stability,distribution,and influencing factors of standardized uptake value(SUV)measured by^(99m)Tc-MDP SPECT/CT imaging of the normal lumbar spine,as well as its value in bone mineral density(BMD)evaluation.Methods A total of 103 patients[13 males and 90 females;age:(54.86±7.84)years]who underwent lumbar vertebra^(99m)Tc-MDP SPECT/CT and BMD evaluation by dual-energy X-ray absorptiometry at 30 days before or after SPECT/CT from May 2021 to June 2023 were retrospectively analyzed.Clinical data,SUVmax,SUVmean,CT value,and BMD of the lumbar spine were collected.The consistency and correlation of lumbar SUV measured by different observers were analyzed by Bland Altman and Pearson correlation analysis.The correlation between lumbar SUV,BMD,CT values,and various parameters was analyzed by Pearson correlation analysis.One-way ANOVA was used to compare the differences of various parameters in subjects with different BMD,and the LSD test was used for comparisons between groups.Results SUVmax and SUVmean showed a good consistency and high correlation between observers,with 1.3%and 3.3%of points located outside the 95%limits of agreement,respectively(r=0.985 and 0.850,respectively,P<0.001 for both).The SUVmax and SUVmean of all 504 lumbar vertebra were 7.91±2.26 and 4.70±1.40,respectively.TLumbar SUVmax and SUVmean gradually increased from L_(1)to L_(3),with L_(3)having the highest value,followed by L_(5)and L_(4).Lumbar SUVmax and SUVmean were significantly negatively correlated with age(P<0.05 for both),and positively correlated with body mass(P<0.001 or 0.05),BMI(P<0.001 for both),and CT value(P<0.05 for both),but they had no significant correlation with height.Lumbar SUVmax and SUVmean were signifcantly positively correlated with BMD obtained in the same period in 83 patients(P<0.05).Lumbar BMD and CT value were significantly negatively correlated with age(P<0.05 or 0.001),and BMD was positively correlated with CT value(P<0.001).There were statistically significant differences in SUVmax,SUVmean,BMD,and CT values among patients with different BMD(P<0.001 for all).Conclusion SUV measured by quantitative SPECT/CT bone imaging is easy to obtain and stable.The distribution and influencing factors must be considered when lumbar SUV is applied in clinical practice.SPECT/CT bone imaging for measuring lumbar SUV has high value in BMD evaluation.