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随着我国人口的老龄化,60岁以上人群骨质疏松症总患病率明显升高,尤其是老年绝经后女性[1-3]。胸腰椎椎体压缩性骨折是骨质疏松症较为常见且严重的后果之一。一旦发生椎体压缩性骨折,将会对患者的生活及经济状况造成明显的影响,包括较高的病死率、持续的背部疼痛、生活质量的下降以及较高的医疗费用支出等。因此,对椎体压缩性骨折进行积极预防以及早期诊断具有重要的临床意义。在近几年的研究中,全身骨显像在骨质疏松症和良恶性椎体骨折、新鲜椎体与陈旧椎体的鉴别诊断中显现了一定的价值[4]。Ap Dafydd等[5]报道了用骨显像与MRI诊断急性、亚急性及陈旧性骨折的一致性为63%,且两者在经皮穿刺椎体成形术及椎体球囊扩张后凸成形术前具有指导意义。目前关于骨显像在骨质疏松性椎体骨折的治疗方案选择方面的应用价值研究尚少。我们回顾性分析了2012年11月至2016年10月因骨质疏松导致的压缩性骨折而就诊于我院的81例绝经后女性,评估99Tcm-MDPSPECT/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压缩性骨折临床治疗方案的选择中的增益价值。
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
Incremental values of 99Tcm-MDP bone scan in postmenopausal women with osteoporotic thoracolumbar vertebral fractures
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摘要:
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。 -
关键词:
- 骨质疏松, 绝经后 /
- 胸椎 /
- 腰椎 /
- 99m锝美罗酸盐 /
- 体层摄影术, 发射型计算机, 单光子 /
- 体层摄影术, X线计算机 /
- 椎体骨折
Abstract:ObjectiveTo assess incremental values of 99Tcm-MDP SPECT/CT bone scan imaging by semi-quantitative analysis indexes for osteoporotic thoracolumbar vertebral fractures in postmenopausal women. MethodsThis 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. ResultsA 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. Conclusion99Tcm-MDP SPECT/CT bone imaging by semi-quantitative analysis can effectively guide treatment of vertebral compression fractures. -
图 2 单发椎体压缩性骨折99Tcm-MDP SPECT/CT骨显像图像。患者女性, 55岁, 无诱因腰部疼痛不适3 d, 变换体位时加重, 诊断为野重度骨质疏松、第1腰椎压缩性骨折冶。入:行野经皮椎体成形术冶后症状明显缓解。图中, A:99TcmMDP骨显像全身后位图, 可见第1腰椎椎体显像剂均匀性分布浓聚影;B:同机CT断层图, 可见第1腰椎椎体双凹性改变;C:99Tcm-MDP SPECT/CT融合图, 黄色线条勾画椎体为病灶椎体邻近椎体第12胸椎, 红色线条勾画椎体为病灶椎体第1腰椎, 病灶椎体与邻近椎体的放射性计数比值T/NT值为3.45。
Figure 2. Images of single vertebral compression fracture with 99TcmMDP SPECT/CT bone imaging
图 3 多发椎体压缩性骨折99Tcm-MDP SPECT/CT骨显像图像。患者女性, 63岁, 腰背部疼痛伴活动受限, 近日逐渐加重。对第2、5腰椎行野经皮椎体成形术冶, 术后症状明显缓解。图中, A:99Tcm-MDP骨显像全身后位图, 可见第12胸椎显像剂分布轻度增高, 第2腰椎均匀性显像剂浓聚影, 第5腰椎局部均匀性显像剂浓聚影;B:同机CT断层矢状位图, 可见第12胸椎及第2、5腰椎压缩性改变;C:99Tcm-MDPSPECT/CT融合图, 可见第12胸椎显像剂轻度增高, 第2、5腰椎均匀性显像剂浓聚影, 粉红色、墨绿色及橙色线条勾画椎体为病灶邻近的正常椎体, 分别对应为第11胸椎及第1、4腰椎, 浅蓝色、深蓝色及深红色线条勾画椎体为病灶椎体, 分别对应为第12胸椎及第2、5腰椎;第12胸椎及第2、5腰椎与邻近椎体的放射性计数比值T/NT值分别为1.08、5.22及1.68。
Figure 3. Images of multiple vertebral compression fractures with99Tcm-MDP SPECT/CT bone imaging
图 4 椎体压缩性骨折合并肋骨骨折99Tcm-MDP SPECT/CT骨显像图像。患者女性, 66岁, 诊断为第8胸椎重度压缩性骨折伴左侧第9后肋骨折。图中, A:99Tcm-MDP骨显像全身后位图, 可见第8腰椎均匀性显像剂浓聚影, 左侧第9后肋点状显像剂浓聚影;B:同机CT断层图, 可见左侧第9后肋骨皮质中断不连续;C:99Tcm-MDP SPECT/CT融合图, 可见左侧第9后肋骨皮质中断伴显像剂分布浓聚;D:同机CT断层矢状位图, 可见第8胸椎椎体重度压缩变扁, 骨皮质尚完整, 并可见气体影;E:99Tcm-MDP SPECT/CT矢状位融合图, 可见第8胸椎椎体中后柱显像剂分布明显浓聚。
Figure 4. Images of vertebral compression fracture combined with rib fracture with99Tcm-MDP SPECT/CT bone imaging
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