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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 238 -244. doi: 10.3877/cma.j.issn.1674-0785.2024.03.002

临床研究

99mTc-MDP SPECT/CT定量骨显像测定腰椎标准化摄取值的分析及应用
张青菊1, 许建林1, 南永刚2, 施常备1, 牛锦云3,†()   
  1. 1. 710061　陕西西安，陕西省肿瘤医院核医学科
    2. 710061　陕西西安，陕西省肿瘤医院体检科
    3. 710061　陕西西安，西安市中心医院核医学科
  • 收稿日期:2023-12-26 出版日期:2024-03-15
  • 通信作者: 牛锦云
  • 基金资助:
    陕西省重点研发计划项目一般项目(2024SF-YBXM-453); 陕西省肿瘤医院国家自然科学基金孵育项目(SC23A02)

Analysis and application of standardized uptake value of the lumbar spine obtained from 99mTc-MDP SPECT/CT quantitative bone imaging

Qingju Zhang1, Jianlin Xu1, Yonggang Nan2, Changbei Shi1, Jinyun Niu3,†()   

  1. 1. Department of Nuclear Medicine, Shaanxi Provincial Cancer Hospital, Xi’an 710061, China
    2. Department of Medical Examination, Shaanxi Provincial Cancer Hospital, Xi’an 710061, China
    3. Department of Nuclear Medicine, Xi 'an Central Hospital, Xi’an 710061, China
  • Received:2023-12-26 Published:2024-03-15
  • Corresponding author: Jinyun Niu
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张青菊, 许建林, 南永刚, 施常备, 牛锦云. 99mTc-MDP SPECT/CT定量骨显像测定腰椎标准化摄取值的分析及应用[J]. 中华临床医师杂志(电子版), 2024, 18(03): 238-244.

Qingju Zhang, Jianlin Xu, Yonggang Nan, Changbei Shi, Jinyun Niu. Analysis and application of standardized uptake value of the lumbar spine obtained from 99mTc-MDP SPECT/CT quantitative bone imaging[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(03): 238-244.

目的

探讨正常腰椎99mTc-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99mTc-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L1~L3逐渐增高，L3最高，其次为L5，L4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L1-L4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。

关键词: 定量单光子发射计算机体层成像/计算机体层成像, 标准摄取值, 腰椎, 骨密度
Objective

To explore the stability, distribution, and influencing factors of standardized uptake value (SUV) measured by 99mTc-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 99mTc-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 L1 to L3, with L3 having the highest value, followed by L5 and L4. 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.

Key words: Quantitative single photon emission computed tomography/computed tomography, Standardized uptake value, Lumbar vertebra, Bone mineral densit
图1 正常腰椎容积感兴趣区（VOI）。图a为轴位CT图像；图b为矢状位CT图像；图c为冠状位CT图像；图d为轴位SPECT图像；图e为矢状位SPECT图像；图f为冠状位SPECT图像，依次勾画VOI，使其边缘与椎体骨皮质重合
图2 SUVmax、SUVmean测量一致性分析。图a为不同观察者测量腰椎SUVmax的一致性分析；图b为不同观察者测量腰椎SUVmean的一致性分析
表1 全部患者基线特征及腰椎SUVmax、SUVmean测量结果
患者特征 范围
年龄（岁）（n=103） 54.86±7.84 38~69
身高（cm）（n=103） 160.59±5.95 150~174
体质量（kg）（n=103） 61.43±8.41 48~86
BMI（n=103） 23.86±2.87 17.93~32.39
*BMD（n=83） 0.83±0.16 0.60~1.25
全部腰椎SUVmax（n=502） 7.91±2.26 4.04~17.40
全部腰椎 SUVmean（n=502） 4.70±1.40 1.40~10.30
L1 SUVmax（n=101） 7.73±0.31 4.15~13.60
L1 SUVmean（n=101） 4.70±0.19 2.61~8.66
L2 SUVmax（n=100） 7.80±0.32 4.03~14.20
L2 SUVmean（n=100） 4.71±0.19 2.37~9.06
L3 SUVmax（n=101） 8.10±0.34 4.79~14.90
L3 SUVmean（n=101） 4.76±0.21 2.34~10.10
L4 SUVmax（n=100） 7.88±0.31 4.61~13.70
L4 SUVmean（n=100） 4.67±0.20 1.93~8.68
L5 SUVmax（n=100） 8.03±0.40 4.25~17.40
L5 SUVmean（n=100） 4.64±0.24 1.40~10.30
图3 腰椎SUVmax、SUVmean分布图
表2 腰椎平均SUVmax、SUVmean与不同指标的相关性分析
临床特征 SUVmax相关性（r） SUVmean相关性（r） BMD相关性（r） CT值相关性（r）
年龄 -0.296* -0.325* -0.378* -0.522△
身高 -0.018 -0.051 0.031 -0.079
体重 0.472△ 0.404* 0.062 0.012
BMI 0.513△ 0.475△ 0.074 0.068
CT值 0.369* 0.343* 0.815△ -
BMD 0.494* 0.433* - -
表3 骨量正常、骨量减低及骨质疏松组患者间临床特征、不同指标差异性比较
临床特征 骨量正常（n=29） 骨量减低（n=29） 骨质疏松（n=25） F值 P值**
年龄 50.69±7.79 56.62±6.36* 58.91±5.03* 5.117 0.11
身高 159±6.57 161.15±5.57 161±3.67 0.744 0.483
体重 61.00±8.77 60.38±8.60 60.82±7.82 0.018 0.982
BMI 23.85±3.19 23.71±2.80 23.27±3.19 0.132 0.877
BMD 9.99±0.14 0.79±0.04* 0.69±0.80*△ 26.916 <0.001
CT 193.53±38.30 142.04±15.90* 116.50±22.23*△ 24.967 <0.001
SUVmax 7.84±1.64 6.72±0.95* 5.61±1.25*△ 8.596 <0.001
SUVmean 5.18±1.01 4.35±0.80* 3.57±0.93*△ 9.243 <0.001
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