Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.
Clin Nucl Med. 2013 Feb;38(2):110-4. doi: 10.1097/RLU.0b013e318279fd23.
Spondylolysis is a defect of the pars interarticularis and is most commonly encountered in the lower lumbar spine of pediatric patients. Stress reaction of the pars interarticularis was regarded as an early stage of this pathological diagnosis in which no obvious anatomical change is detected. Both SPECT with (99m)Tc MDP and CT of the lumbar spine have been used to evaluate the patients with low back pain. The purpose of this study was to determine the prevalence of stress reaction in pars interarticularis in pediatric patients presenting new-onset back pain using both bone SPECT and CT.
The records and images of 63 consecutive pediatric patients (mean age, 13.2 years) with new onset of back pain, who received both (99m)Tc MDP bone scintigraphy with SPECT of the lumbar spine and lumbar thin-slice CT were retrospectively analyzed. The results of bone SPECT and CT were retrospectively compared.
Among the cohort of 63 patients who had both bone SPECT and thin-slice CT of the lumbar spine, there was a total of 56 positive SPECT results indicating stress injuries in the pars interarticularis. Spondylolysis was shown on both bone SPECT and thin-slice CT in 45 patients. In 11 patients, stress reaction was shown. In 7 patients, no abnormality was detected by either SPECT or thin-slice CT.
Our result showed that a significant portion (19.6%, 11 of 56) of the stress injuries in the pars interarticularis will be CT-negative stress reaction in pediatric patients with new-onset back pain.
脊椎裂是椎弓峡部的缺损，最常见于小儿下腰椎。椎弓峡部的应力反应被认为是这种病理诊断的早期阶段，在此阶段没有明显的解剖学变化。SPECT 与（99m）Tc MDP 以及腰椎 CT 都被用于评估腰痛患者。本研究旨在通过骨 SPECT 和 CT 评估新发腰痛的小儿患者中椎弓峡部应力反应的发生率。
回顾性分析了 63 例连续新发腰痛的小儿患者（平均年龄 13.2 岁）的病历和图像，他们均接受了腰椎（99m）Tc MDP 骨扫描 SPECT 和腰椎薄层 CT 检查。回顾性比较骨 SPECT 和 CT 的结果。
在接受腰椎 SPECT 和薄层 CT 检查的 63 例患者中，共有 56 例 SPECT 结果阳性，提示椎弓峡部应力损伤。45 例患者的 SPECT 和薄层 CT 均显示脊椎裂。11 例患者表现为应力反应。7 例患者 SPECT 和薄层 CT 均未发现异常。
我们的结果表明，新发腰痛的小儿患者中，相当一部分（19.6%，56 例中的 11 例）椎弓峡部的应力损伤在 CT 上表现为阴性的应力反应。
