无神经根体征的伸展性下背痛的单光子发射计算机断层扫描（SPECT）

Chung Chin-Teng, Wang Chun-Fu, Chou Chrong-Song, Wang Shyh-Jen, Kao Chia-Hung, Lan Haw-Chang

Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC. ctchung @vghtc.vghtc.gov.tw

J Chin Med Assoc. 2004 Jul;67(7):349-54.

BACKGROUND

Low back pain (LBP) is very common in the general population. Most patients with LBP will receive an X-ray examination on lumbar spine; however, the results are likely to show a negative finding or degenerative joint disease, which are not truly pathological factors. Among various imaging diagnostic tools for active bony lesions of lumbar spine, planar bone scintigraphy has a higher sensitivity, but its ability to locate anatomic lesions is less satisfactory. The purpose of this study was to investigate the role of SPECT for evaluation of LBP.

METHODS

Fifty-two consecutive patients who had low back pain induced by extension were studied. They had no evidence of malignant tumor, immune disease, spinal infection and neurological disorder by history-taking and physical examination. All patients received planar bone scintigraphy and SPECT exams following an X-ray examination. The results of X-ray finding were grouped into 3 categories: (A) normal; (B) degenerative joint arthritis; (C) spondylolysis. The data of test results and clinical evaluation were then used for analysis.

RESULTS

Twenty (38.5%) out of 52 patients examined by planar scan had abnormality, with 29 increased uptake lesions, compared with 28 (53.8%) out of 52 patients with 60 increased uptake lesions by SPECT with planar scan; SPECT disclosed 1-2 more lesions with improved location in 15 patients (p < 0.05). Of the 52 patients, 21 (40.4%) presented in group A, 21 (40.4%) in group B, and 10 (19.2%) in group C according to the X-ray examination. In group A, 9 out of 21 (42.9%) patients had an abnormal SPECT result, compared to 5 of 10 (50%) in group B, and 14 out of 21 (66.7%) in group C, respectively (p > 0.05). The location of abnormal uptake on L-spine included vertebral body and arch (57.1%), vertebral arch (28.6%), and vertebral body (14.3%). Most of lesions (91.5%) were distributed at the 4th and 5th lumbar vertebral segments.

CONCLUSIONS

SPECT was more sensitive and located more lesions than planar bone scintigraphy, especially when the lesions were located at posterior element of vertebrae. Most of the lesions were distributed at the 4 th and 5 th lumbar vertebral segments. There was no significant statistical difference of abnormal SPECT related to X-ray finding. The use of SPECT was the first choice among all image modalities when cause of low back pain was assumed to arise from bone and joint disorder at clinical evaluation.

背景

下腰痛（LBP）在普通人群中非常常见。大多数LBP患者会接受腰椎X线检查；然而，结果往往显示为阴性或退行性关节病，并非真正的病理因素。在用于腰椎活动性骨病变的各种影像学诊断工具中，平面骨闪烁显像具有较高的敏感性，但其对解剖病变的定位能力不太令人满意。本研究的目的是探讨单光子发射计算机断层显像（SPECT）在评估LBP中的作用。

方法

对52例因伸展诱发下腰痛的连续患者进行研究。通过病史采集和体格检查，他们没有恶性肿瘤、免疫疾病、脊柱感染和神经疾病的证据。所有患者在X线检查后接受平面骨闪烁显像和SPECT检查。X线检查结果分为3类：（A）正常；（B）退行性关节炎；（C）椎弓峡部裂。然后将检查结果和临床评估数据用于分析。

结果

平面扫描检查的52例患者中，20例（38.5%）有异常，有29个摄取增加的病变，而SPECT联合平面扫描检查的52例患者中有28例（53.8%）有60个摄取增加的病变；SPECT在15例患者中多发现1 - 2个病变且定位更准确（p < 0.05）。根据X线检查，52例患者中，A组21例（40.4%），B组21例（40.4%），C组10例（19.2%）。A组中，21例患者中有9例（42.9%）SPECT结果异常，B组10例中有5例（50%），C组21例中有14例（66.7%），差异无统计学意义（p > 0.05）。腰椎异常摄取的部位包括椎体和椎弓（57.1%）、椎弓（28.6%）和椎体（14.3%）。大多数病变（91.5%）分布在第4和第5腰椎节段。