Harisankar Chidambaram Natrajan Balasubramanian, Mittal Bhagwant Rai, Bhattacharya Anish, Singh Paramjeet, Sen Ramesh
Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Nucl Med. 2012 Jul;27(3):156-63. doi: 10.4103/0972-3919.112720.
Abnormal morphologic findings in imaging were thought to explain the etiology of low back pain (LBP). However, it is now known that variety of morphologic abnormalities is noted even in asymptomatic individuals. Single photon emission computed tomography/computed tomography (SPECT/CT) could be used to differentiate incidental findings from clinically significant findings.
This study was performed to define the SPECT/CT patterns in patients with LBP and to correlate these with clinical and magnetic resonance imaging (MRI) findings.
Thirty adult patients with LBP of duration 3 months or more were prospectively evaluated in this study. Patients with known or suspected malignancy, trauma or infectious processes were excluded. A detailed history of sensory and motor symptoms and neurologic examination was performed. All the patients were subjected to MRI and bone scintigraphy with hybrid SPECT/CT of the lumbo-sacral spine within 1 month of each other. The patients were classified into those with and without neurologic symptoms, activity limitation. The findings of clinical examination and imaging were compared. MRI and SPECT/CT findings were also compared.
Thirty patients (18 men and 12 women; mean age 38 years; range 17-64 years) were eligible for the study. Clinically, 14 of 30 (46%) had neurologic signs and or symptoms. Six of the 30 patients (20%) had positive straight leg raising test (SLRT). Twenty-two of the 30 patients (73%) had SPECT abnormality. Most frequent SPECT/CT abnormality was tracer uptake in the anterior part of vertebral body with osteophytes/sclerotic changes. Significant positive agreement was noted between this finding and MRI evidence of degenerative disc disease. Only 13% of patients had more than one abnormality in SPECT. All 30 patients had MRI abnormalities. The most frequent abnormality was degenerative disc disease and facet joint arthropathy. MRI showed single intervertebral disc abnormality in 36% of the patients and more than one intervertebral disc abnormality in remaining 64% patients. Fifteen of the 30 patients had facet joint arthropathy. 60% of these patients had involvement of more than one level facet joints while 38% had associated inter vertebral disc disease. 83% of the patients with positive SLRT had SPECT and MRI abnormalities. 100% of patients with neurologic symptoms had SPECT and MRI abnormalities.
Addition of hybrid SPECT/CT data will help differentiate incidental from significant MRI abnormalities as all patients with LBP have MRI abnormalities and most have MRI abnormalities at multiple sites. Tracer uptake in the anterior part of the vertebral body represents degenerative disc disease. MRI is sensitive and SPECT/CT is specific for facet joint arthropathy. Both investigations are best used complementary to each other.
影像学检查中发现的形态学异常曾被认为可以解释腰痛（LBP）的病因。然而，现在已知即使在无症状个体中也能发现多种形态学异常。单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）可用于区分偶然发现与具有临床意义的发现。
本研究旨在确定LBP患者的SPECT/CT模式，并将其与临床和磁共振成像（MRI）结果相关联。
本研究前瞻性评估了30例病程3个月及以上的成年LBP患者。排除已知或疑似患有恶性肿瘤、创伤或感染性疾病的患者。进行了详细的感觉和运动症状病史及神经系统检查。所有患者在彼此1个月内接受了腰骶椎的MRI和骨闪烁显像及混合SPECT/CT检查。将患者分为有和无神经症状、活动受限的两组。比较临床检查和影像学检查结果。还比较了MRI和SPECT/CT检查结果。
30例患者（18例男性和12例女性；平均年龄38岁；范围17 - 64岁）符合研究条件。临床上，30例中有14例（46%）有神经体征和/或症状。30例患者中有6例（20%）直腿抬高试验（SLRT）阳性。30例患者中有22例（73%）有SPECT异常。最常见的SPECT/CT异常是椎体前部有骨赘/硬化改变处的示踪剂摄取。这一发现与椎间盘退变的MRI证据之间存在显著的正相关。只有13%的患者SPECT有不止一处异常。所有30例患者均有MRI异常。最常见的异常是椎间盘退变和小关节病。MRI显示36%的患者有单个椎间盘异常，其余64%的患者有不止一个椎间盘异常。30例患者中有15例有小关节病。这些患者中有60%累及不止一个节段的小关节，38%伴有椎间盘疾病。SLRT阳性的患者中有83%有SPECT和MRI异常。有神经症状的患者中有100%有SPECT和MRI异常。
由于所有LBP患者都有MRI异常且大多数患者在多个部位有MRI异常，因此添加混合SPECT/CT数据有助于区分偶然的MRI异常与具有临床意义的异常。椎体前部的示踪剂摄取代表椎间盘退变。MRI对小关节病敏感，SPECT/CT对小关节病具有特异性。两种检查最好相互补充使用。
