Parghane Rahul V, Singh Baljinder, Sharma Aman, Singh Harmandeep, Singh Paramjeet, Bhattacharya Anish
Department of Nuclear Medicine and PET Centre, PGIMER, Chandigarh, India.
Division of Rheumatology, Department of Internal Medicine, PGIMER, Chandigarh, India; and.
J Nucl Med Technol. 2017 Dec;45(4):280-284. doi: 10.2967/jnmt.117.193094. Epub 2017 Aug 10.
Our rationale was to evaluate the role of Tc-methylene diphosphonate (Tc-MDP) SPECT/CT for the detection of sacroiliitis in spondyloarthropathies by comparing it with clinical markers and MRI findings. We prospectively included 155 patients (83 men and 72 women; mean age, 35.80 ± 12.40 y; range, 18-60 y) diagnosed with spondyloarthropathies as per the criteria of the European Spondyloarthropathy Study Group. All patients underwent clinical evaluation (using the Bath ankylosing spondylitis disease activity index [BASDAI]), measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, planar Tc-MDP bone scintigraphy, SPECT/CT, and MRI of the pelvic region. Using MRI as the reference criterion, the diagnostic accuracy of the clinical and scintigraphic parameters was assessed. On planar bone scintigraphy and SPECT, a score of 0, 1, or 2 was assigned when tracer uptake in the sacroiliac joint was less than, equal to, or more than that in the sacrum. A score of 2 was considered positive for the diagnosis of sacroiliitis. The sensitivity, specificity, accuracy, and positive and negative predictive values of Tc-MDP SPECT/CT were 90.0%, 80.0%, 87.0%, 92.0%, and 75.0%, respectively. The accuracy of SPECT/CT (87%) was better than that of ESR (58.1%), CRP (32.9%), BASDAI scoring (77%), and planar bone scintigraphy (53%). Similar results were found for sensitivity and negative predictive value. Regarding specificity, SPECT/CT (80%) was lower than BASDAI scoring (88.6%) and equal to planar bone scintigraphy (80%). Regarding positive predictive value, SPECT/CT (92%) was a bit lower than BASDAI scoring (93.6%). κ-values for planar Tc-MDP bone scanning and SPECT/CT were 0.167 and 0.673, respectively, indicating poor agreement for planar bone scanning and good agreement for SPECT/CT. A significant ( < 0.001) correlation ( = 0.659) was observed between SPECT/CT and MRI findings. Tc-MDP SPECT/CT has diagnostic accuracy comparable to that of MRI for the evaluation of sacroiliitis in spondyloarthropathies and can thus be used as an alternative when MRI is contraindicated. SPECT/CT shows better accuracy than planar bone scintigraphy, ESR, CRP, and BASDAI scoring in the diagnosis of sacroiliitis.
我们的研究目的是通过将锝-亚甲基二膦酸盐（Tc-MDP）单光子发射计算机断层显像/计算机断层扫描（SPECT/CT）与临床指标及磁共振成像（MRI）结果进行比较，评估其在脊柱关节病骶髂关节炎检测中的作用。我们前瞻性纳入了155例根据欧洲脊柱关节病研究组标准诊断为脊柱关节病的患者（83例男性和72例女性；平均年龄35.80±12.40岁；范围18 - 60岁）。所有患者均接受了临床评估（使用巴斯强直性脊柱炎疾病活动指数[BASDAI]）、红细胞沉降率（ESR）和C反应蛋白（CRP）水平测定、平面Tc-MDP骨闪烁显像、SPECT/CT以及骨盆区域的MRI检查。以MRI作为参考标准，评估临床和闪烁显像参数的诊断准确性。在平面骨闪烁显像和SPECT上，当骶髂关节的示踪剂摄取低于、等于或高于骶骨时，分别给予0、1或2分。2分被认为骶髂关节炎诊断为阳性。Tc-MDP SPECT/CT的敏感性、特异性、准确性以及阳性和阴性预测值分别为90.0%、80.0%、87.0%、92.0%和75.0%。SPECT/CT的准确性（87%）优于ESR（58.1%）、CRP（32.9%）、BASDAI评分（77%）和平面骨闪烁显像（53%）。在敏感性和阴性预测值方面也发现了类似结果。关于特异性，SPECT/CT（80%）低于BASDAI评分（88.6%）且与平面骨闪烁显像（80%）相当。关于阳性预测值，SPECT/CT（92%）略低于BASDAI评分（93.6%）。平面Tc-MDP骨扫描和SPECT/CT的κ值分别为0.167和0.673，表明平面骨扫描一致性差，SPECT/CT一致性好。观察到SPECT/CT与MRI结果之间存在显著相关性（<0.001）（r = 0.659）。在评估脊柱关节病骶髂关节炎方面，Tc-MDP SPECT/CT具有与MRI相当的诊断准确性，因此在MRI禁忌时可作为替代方法使用。在骶髂关节炎诊断中，SPECT/CT显示出比平面骨闪烁显像、ESR、CRP和BASDAI评分更高的准确性。
