Is there Still Enough Diagnostic Confidence with Bone Spect Scintigraphy Alone: A Retrospective Evaluation and Extended Review of the Literature

S. Gratz, H. Höffken, W. Kaiser, K. Klose, T. Behr
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引用次数: 3

Abstract

Aim: Single photon emission computed tomography (SPECT) dramatically increases the sensitivity of bone scanning for detection of spinal abnormalities. However, the level of specificity obtained by SPECT remains controversial and increased diagnostic confidence can be obtained with new imaging modalities such as fused PET/CT and SPECT/CT. Patients and Methods: Between 7/2005 and 7/2007 ninety one patients with different malignant primary tumors were in- vestigated. Following injection of 555 MBq 99m Tc - MDP planar and SPECT images were performed in all patients. Re- sults: Out of a total of 145 spinal lesions was confirmed by radiography, SPECT detected 133 (91%). In contrast, planar scintigraphy detected only 99/145 (68%) lesions. SPECT uptake pattern including the vertebral body and an adjacent pedicle was seen in 9/28 (32%) of metastatic lesions and in 1/2 (50%) cases of spondylitis. SPECT uptake pattern includ- ing the pedicle alone was seen in 45/115 (39%) of degenerative alterations. Focal lesions limited to the lateral part of the vertebral body, especially to the pars interarticularis (n=8), facet joints (n=14) and costotransversal joints (n=6), were cor- rectly diagnosed as spondylarthrosis and costotransversalarthrosis in all cases. Furthermore, SPECT uptake pattern of spondylitis was biconcave, whereas metastatic lesions showed focal or linear uptakes. Conclusion: SPECT without image fusion still gives sufficient diagnostic confidence for the differentiation of benign and malignant spine lesions. Uptake pat- terns localized at the facet joints or localized at the pedicles are indicative for benign lesions, whereas continuous uptake patterns of the vertebral body and adjacent pedicle remain suspicious for malignancy.
骨显像是否仍有足够的诊断信心:回顾性评价和文献综述
目的:单光子发射计算机断层扫描(SPECT)显著提高骨扫描检测脊柱异常的灵敏度。然而,SPECT获得的特异性水平仍然存在争议,新的成像方式如PET/CT和SPECT/CT融合可以提高诊断的可信度。患者与方法:于2005年7月至2007年7月对91例不同类型的原发性恶性肿瘤患者进行了调查。注射555mbq 99m后,对所有患者进行Tc - MDP平面和SPECT成像。结果:经x线摄影证实的145例脊柱病变中,SPECT检出133例(91%)。相比之下,平面闪烁成像仅检测到99/145(68%)病变。在9/28(32%)的转移性病变和1/2(50%)的脊柱炎病例中可以看到包括椎体和邻近椎弓根的SPECT摄取模式。45/115(39%)的退行性改变中SPECT摄取模式仅包括椎弓根。局限于椎体外侧部分的局灶性病变,特别是关节间部(n=8)、小关节(n=14)和肋横关节(n=6),在所有病例中都被直接诊断为脊柱关节病和肋横关节病。此外,脊柱炎的SPECT摄取模式是双凹的,而转移性病变显示局灶性或线状摄取。结论:不进行图像融合的SPECT对脊柱良恶性病变的鉴别仍有足够的诊断信心。摄取模式局限于小关节或椎弓根提示良性病变,而椎体和邻近椎弓根的连续摄取模式则提示恶性病变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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