Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Ann Nucl Med. 2013 Jun;27(5):460-7. doi: 10.1007/s12149-013-0707-7. Epub 2013 Mar 5.
Metastases and benign conditions of spine are common, however, the diagnoses of imaging modalities in the nature of spinal lesions are difficult, especially for the solitary lesions in spine. This study aims to retrospectively evaluate the diagnostic value of single photon emission computed tomography (SPECT)/spiral computed tomography (CT) in assessing indeterminate spinal solitary lesion of patients without certain medical history of malignancies.
A total of 48 patients (28 male, 20 female, average 54.9 ± 14.8 years) without malignant history but with a solitary lesion of spine on the Tc-99m-methylene diphosphonate planar scintigraphy, were enrolled in this study. SPECT/spiral CT was simultaneously performed on the abnormal lesions of the spine. SPECT alone and SPECT/spiral CT images were independently analyzed and interpreted by two experienced nuclear medicine physicians. Finally, the indeterminate spinal single lesion was confirmed with pathological results. The agreements of the SPECT and SPECT/spiral CT diagnoses with the pathology were evaluated using a weighted kappa score, respectively.
Among 48 patients, the pathological results revealed 37.5 % (18/48) benign and 62.5 % (30/48) malignant lesions. For SPECT alone, 6 of 18 benign cases and 28 of 30 malignant conditions were correctly diagnosed. For SPECT/spiral CT, 9 of 18 benign and 29 of 31 malignant lesions were exactly judged. For these patients without malignant history, the diagnostic accuracy, specificity, positive predictive value, and negative predictive value of SPECT and SPECT/spiral CT in assessing abnormal spinal solitary lesion were 70.8 % (34/48) vs 79.2 % (38/48), 33.3 % (6/18) vs 50.0 % (9/18), 70.0 % (28/40) vs 76.3 % (29/38), 75.0 % (6/8) vs 90.0 % (9/10), respectively. Moreover, the kappa scores for the agreement of SPECT alone and SPECT/spiral CT with the pathological confirmation were 0.300 and 0.512, respectively (both P < 0.005).
Compared with SPECT imaging, hybrid SPECT/spiral CT imaging improves the diagnostic accuracy and specificity in evaluating indeterminate spinal solitary lesion of patients without certain malignant history. Moreover, based on whole-body bone scan with high sensitivity, cheap price, widespread and time-saving use, SPECT/spiral CT is a good imaging modality for the diagnosis and evaluation of the nature of solitary lesion in spine.
脊柱的转移和良性病变很常见，然而，影像学检查对脊柱病变性质的诊断较为困难，尤其是对脊柱单发病变的诊断。本研究旨在回顾性评估单光子发射计算机断层扫描（SPECT）/螺旋计算机断层扫描（CT）在评估无明确恶性肿瘤病史的脊柱单发病变患者中的诊断价值。
本研究共纳入 48 例无恶性肿瘤病史但经锝-99m-亚甲基二膦酸盐平面闪烁扫描发现脊柱单发病变的患者（男 28 例，女 20 例，平均年龄 54.9±14.8 岁）。对脊柱异常病变行 SPECT/螺旋 CT 检查。由 2 名有经验的核医学医师分别对 SPECT 图像和 SPECT/螺旋 CT 图像进行独立分析和解读。最后，通过病理结果证实脊柱单发的不确定病变。分别采用加权 kappa 评分评估 SPECT 和 SPECT/螺旋 CT 诊断与病理结果的一致性。
48 例患者中，病理结果显示良性病变 37.5%（18/48），恶性病变 62.5%（30/48）。SPECT 单独检查时，18 例良性病变中 6 例、30 例恶性病变中 28 例得到正确诊断。SPECT/螺旋 CT 检查时，18 例良性病变中 9 例、31 例恶性病变中 29 例得到准确判断。对于这些无恶性肿瘤病史的患者，SPECT 和 SPECT/螺旋 CT 评估脊柱单发异常病变的诊断准确率、特异性、阳性预测值和阴性预测值分别为 70.8%（34/48）和 79.2%（38/48）、33.3%（6/18）和 50.0%（9/18）、70.0%（28/40）和 76.3%（29/38）、75.0%（6/8）和 90.0%（9/10）。此外，SPECT 单独检查和 SPECT/螺旋 CT 与病理结果的一致性kappa 评分分别为 0.300 和 0.512（均 P<0.005）。
与 SPECT 成像相比，SPECT/螺旋 CT 成像可提高无明确恶性肿瘤病史患者脊柱单发病变的诊断准确率和特异性。此外，SPECT/螺旋 CT 结合全身骨扫描，具有高灵敏度、价格低廉、广泛应用、省时等优点，是诊断和评估脊柱单发病变性质的良好影像学方法。
