单光子发射计算机断层显像/CT在脊柱外科精准诊断定位应用中的临床问题分析
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摘要
背景:目前MRI等检查在脊柱外科某些疾病的精准诊断定位中存在一定的局限性,随着单光子发射计算机断层显像/CT在脊柱外科得到广泛应用,逐渐发现其在临床诊断定位方面具有独特的价值和优势。目的:评估单光子发射计算机断层显像/CT在脊柱外科精准诊断定位方面的应用价值。方法:将2017年1至12月在青岛市市立医院东院住院患者单光子发射计算机断层显像/CT检查与X射线、CT、MRI等影像学比较,总结分析单光子发射计算机断层显像/CT在腰椎小关节突紊乱、胸腰椎体压缩性骨折、术后腰背部疼痛以及脊柱恶性肿瘤诊断定位中的优势及存在的问题。结果与结论:(1)单光子发射计算机断层显像/CT因为灵敏度高的特点,在腰椎小关节突紊乱、术后腰背部疼痛以及脊柱恶性肿瘤的早期诊断方面具有独特的优势;(2)然而单光子发射计算机断层显像/CT特异性差,在胸腰椎压缩性骨折等诊断方面存在假阳性率,而在溶骨性破坏的脊柱肿瘤诊断方面存在假阴性率;(3)提示单光子发射计算机断层显像/CT在脊柱外科精准诊断定位方面具有重要临床应用价值。
BACKGROUND: MRI has some limitations in the accurate diagnosis and localization of some diseases in spine surgery. With the wide application of single photon emission computed tomography/CT in spine surgery, it has unique value and advantages in clinical diagnosis and localization. OBJECTIVE: To evaluate the application value of single photon emission computed tomography/CT in accurate diagnosis and location of spine surgery. METHODS: The imaging examination of single photon emission computed tomography/CT and X-ray, CT and MRI of the patients at Eastern Branch of Qingdao Municipal Hospital from January to December 2017 were compared. The advantages and problems of single photon emission computed tomography/CT in the diagnosis and localization of lumbar facet joint disorder, thoracolumbar vertebral compression fracture, postoperative lumbar and back pain, and spinal malignant tumors were summarized and analyzed. RESULTS AND CONCLUSION:(1) Due to high sensitivity, single photon emission computed tomography/CT has a unique advantage in lumbar facet joint disorder, postoperative lumbar back pain, and early diagnosis of spinal malignant tumors.(2) However, there is a false positive rate in the diagnosis of thoracolumbar vertebral compression fracture, but there is a false negative rate in the diagnosis of spinal tumors with osteolytic destruction.(3) Single photon emission computed tomography/CT is of great value in the clinical application of precise diagnosis and location in spine surgery.
BACKGROUND: MRI has some limitations in the accurate diagnosis and localization of some diseases in spine surgery. With the wide application of single photon emission computed tomography/CT in spine surgery, it has unique value and advantages in clinical diagnosis and localization. OBJECTIVE: To evaluate the application value of single photon emission computed tomography/CT in accurate diagnosis and location of spine surgery. METHODS: The imaging examination of single photon emission computed tomography/CT and X-ray, CT and MRI of the patients at Eastern Branch of Qingdao Municipal Hospital from January to December 2017 were compared. The advantages and problems of single photon emission computed tomography/CT in the diagnosis and localization of lumbar facet joint disorder, thoracolumbar vertebral compression fracture, postoperative lumbar and back pain, and spinal malignant tumors were summarized and analyzed. RESULTS AND CONCLUSION:(1) Due to high sensitivity, single photon emission computed tomography/CT has a unique advantage in lumbar facet joint disorder, postoperative lumbar back pain, and early diagnosis of spinal malignant tumors.(2) However, there is a false positive rate in the diagnosis of thoracolumbar vertebral compression fracture, but there is a false negative rate in the diagnosis of spinal tumors with osteolytic destruction.(3) Single photon emission computed tomography/CT is of great value in the clinical application of precise diagnosis and location in spine surgery.
引文
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[13]郭宝英,朱魏,赵太茂.原发性骨质疏松椎体压缩性骨折的X线、MRI影像诊断价值分析[J].中国CT和MRI杂志,2016,14(11):124-126.
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[15]Kaneta T,Ogawa M,Daisaki H,et al.SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate.Am J Nucl Med Mol Imaging.2016;6(5):262-268.
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[18]陈海龙,郑九琴,马俊杰,等.SPECT/CT对椎间盘源性腰痛的诊断价值[J].中华骨与关节外科杂志,2017,10(3):191-194.
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[23]Erba PA,Israel O.SPECT/CT in infection and inflammation.Clin Trans Imaging.2014;2(6):519-535.
[24]张雪辉,孔飚,肖国有,等.SPECT/CT显像对脊柱良恶性病变诊断的增益价值[J].中华核医学与分子影像杂志,2016,36(2):156-160.
[25]Rager O,Nkoulou R,Exquis N,et al.Whole-body SPECT/CTversus planar bone scan with targeted spect/ct for metastatic workup.Bio Med Res Int.2017;2017(7):7039406.
[26]Song-Ke YU,Chen XL,Jiang SX.Value of~(99)TC~m-MDPSPECT/CT imaging fusion in diagnosis of atypical bone metastasis tumor.Lab Med Clin.2016.
[27]王东,孟宪平,陈则君,等.SPECT/CT融合图像与全身骨显像对骨转移瘤诊断的价值分析[J].中国CT和MRI杂志,2016,14(4):126-129.
[28]Umeda T,Koizumi M,Fukai S,et al.Evaluation of bone metastatic burden by bone SPECT/CT in metastatic prostate cancer patients:defining threshold value for total bone uptake and assessment in radium-223 treated patients.Ann Nucl Med.2017;32(2):105-113.
[2]Palyo RJ,Sinusas AJ,Liu YH.High-sensitivity and high-resolution SPECT/CT systems provide substantial dose reduction without compromising quantitative precision for assessment of myocardial perfusion and function.J Nucl Med.2016;57(6):893-899.
[3]石洪成.SPECT/CT的临床应用:在优势互补中寻求亮点[J].中华核医学与分子影像杂志,2017,37(7):385-387.
[4]Luoma K,Vehmas T,Kerttula L,et al.Chronic low back pain in relation to Modic changes,bony endplate lesions,and disc degeneration in a prospective MRI study.Eur Spine J.2016;25(9):2873-81.
[5]中国康复医学会脊柱脊髓专业委员会专家组.中国急/慢性非特异性腰背痛诊疗专家共识[J].中国脊柱脊髓杂志,2016,26(12):1134-1138.
[6]En’Wezoh DC,Leonard DA,Schoenfeld AJ,et al.Relationship between size of disc and early postoperative outcomes after lumbar discectomy.Arch Orthop Trauma Surg.2017;137(6):805-811.
[7]Russo VM,Dhawan RT,Baudracco I,et al.Hybrid bone spect/ct imaging in evaluation of chronic low back pain:correlation with facet joint arthropathy.World Neurosurg.2017;107:732.
[8]Matesan M,Behnia F,Bermo M,et al.SPECT/CT bone scintigraphy to evaluate low back pain in young athletes:common and uncommon etiologies.J Orthop Surg Res.2016;11(1):76.
[9]Inki L,Hendra B,Youn MJ,et al.The value of SPECT/CT in localizing pain site and prediction of treatment response in patients with chronic low back pain.J Korean Med Sci.2014;29(12):1711-1716.
[10]权正学,郝杰.骨质疏松性椎体压缩骨折的影像学诊断[J].中华创伤杂志,2016,32(9):769-771.
[11]Nakashima D,Kanchiku T,Nishida N,et al.Finite element analysis of compression fractures at the thoracolumbar junction using models constructed from medical images.Exp Ther Med.2018;15(4):3225-3230.
[12]江晓兵,莫凌,姚珍松,等.SPECT、SPECT-CT与MRI对新鲜骨质疏松性椎体压缩骨折的诊断价值[J].中国脊柱脊髓杂志,2013,23(10):891-897.
[13]郭宝英,朱魏,赵太茂.原发性骨质疏松椎体压缩性骨折的X线、MRI影像诊断价值分析[J].中国CT和MRI杂志,2016,14(11):124-126.
[14]Delcroix O,Robin P,Gouillou M,et al.A new SPECT/CTreconstruction algorithm:reliability and accuracy in clinical routine for non-oncologic bone diseases.EJNMMI Res.2018;8(1):14.
[15]Kaneta T,Ogawa M,Daisaki H,et al.SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate.Am J Nucl Med Mol Imaging.2016;6(5):262-268.
[16]Farrokhi MR,Lotfi M,Masoudi MS,et al.Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy:a triple-blind,randomized placebo-controlled trial.J Neurosurg Spine.2016;24(1):7-15.
[17]Crawford CH 3rd,Glassman SD,Mummaneni PV,et al.Back pain improvement after decompression without fusion or stabilization in patients with lumbar spinal stenosis and clinically significant preoperative back pain.J Neurosurg Spine.2016;25(5):596-601.
[18]陈海龙,郑九琴,马俊杰,等.SPECT/CT对椎间盘源性腰痛的诊断价值[J].中华骨与关节外科杂志,2017,10(3):191-194.
[19]Duce V,Manca G,Mazzarri S,et al.Sentinel node mapping in melanoma of the back:SPECT/CT helps discriminate"true"and"false"in-transit lymph nodes.Clin Nucl Med.2016;41(1):e66.
[20]Ain A,Jain S,Agarwal A,et al.Evaluation of efficacy of bone scan with SPECT/CT in the management of low back pain:a study supported by differential diagnostic local anesthetic blocks.Clin JPain.2015;31(12):1054-1059.
[21]Hudyana H,Maes A,Vandenberghe T,et al.Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws.Eur J Nucl Med Mol Imaging.2016;43(2):349-354.
[22]张斌青,郭会利,张敏.SPECT/CT对腰椎融合术后疼痛原因的诊断价值[J].中华核医学与分子影像杂志,2017,37(7):392-394.
[23]Erba PA,Israel O.SPECT/CT in infection and inflammation.Clin Trans Imaging.2014;2(6):519-535.
[24]张雪辉,孔飚,肖国有,等.SPECT/CT显像对脊柱良恶性病变诊断的增益价值[J].中华核医学与分子影像杂志,2016,36(2):156-160.
[25]Rager O,Nkoulou R,Exquis N,et al.Whole-body SPECT/CTversus planar bone scan with targeted spect/ct for metastatic workup.Bio Med Res Int.2017;2017(7):7039406.
[26]Song-Ke YU,Chen XL,Jiang SX.Value of~(99)TC~m-MDPSPECT/CT imaging fusion in diagnosis of atypical bone metastasis tumor.Lab Med Clin.2016.
[27]王东,孟宪平,陈则君,等.SPECT/CT融合图像与全身骨显像对骨转移瘤诊断的价值分析[J].中国CT和MRI杂志,2016,14(4):126-129.
[28]Umeda T,Koizumi M,Fukai S,et al.Evaluation of bone metastatic burden by bone SPECT/CT in metastatic prostate cancer patients:defining threshold value for total bone uptake and assessment in radium-223 treated patients.Ann Nucl Med.2017;32(2):105-113.