Department of Radiology, Rush University Medical Center, Chicago, IL.
Department of Radiology and Nuclear Medicine, University of Washington, Seattle, WA.
J Neuroimaging. 2018 Nov;28(6):635-639. doi: 10.1111/jon.12533. Epub 2018 Jul 10.
To assess benefits of hybrid (single photon emission computerized tomography [SPECT]/computed tomography [CT]) imaging over SPECT imaging only in the management of young athletes with low back pain (LBP) due to suspected pars interarticularis fracture.
Retrospectively reviewed medical records of 163 consecutive patients who had radionuclide SPECT imaging for evaluation of LBP between January 1, 2010 and December 30, 2015. All enrolled patients were divided into two groups (group 1: patients with radionuclide SPECT imaging only and group 2: patients with radionuclide hybrid imaging). Radiation dose, cost benefits, and mean duration of delay in complete diagnosis were assessed and compared using Fisher's exact test.
A total of 91 patients were enrolled after applying inclusion and exclusion criteria. The volume CT dose index and dose length product (DLP) estimated for a scan length of 10 cm (DLP 10) were significantly lower for patients in group II (CTDI ) (P = .001 and P = .001). Although, there was no significant difference in actual DLP (P = .52). There was a median delay of 7 days (interquartile range 2-10 days) for complete diagnosis in group I patients. Least expensive imaging for early definitive diagnosis required for the treatment decisions was in patients who had a radionuclide Technetium-99m methylene diphosphonate bone scan with limited lumbar spine planar and SPECT imaging followed by a thin slice, limited CT performed only when SPECT imaging was positive for an active pars interarticularis fracture. No significant difference in the management of patients between the groups (P = .47).
Hybrid imaging should be preferred over SPECT only imaging for initial evaluation of suspected pars interarticularis fracture in young athletes with LBP.
评估在疑似关节突间骨折导致的年轻运动员腰痛（LBP）患者管理中，与单纯单光子发射计算机断层扫描（SPECT）成像相比，混合（SPECT/计算机断层扫描 [CT]）成像的优势。
回顾性分析 2010 年 1 月 1 日至 2015 年 12 月 30 日期间因 LBP 接受放射性核素 SPECT 成像评估的 163 例连续患者的病历。所有入组患者分为两组（组 1：仅行放射性核素 SPECT 成像的患者；组 2：行放射性核素混合成像的患者）。使用 Fisher 确切检验评估并比较辐射剂量、成本效益和完全诊断的平均延迟时间。
应用纳入和排除标准后，共纳入 91 例患者。对于扫描长度为 10 cm 的容积 CT 剂量指数（CTDI）和剂量长度乘积（DLP10），组 2 的患者明显较低（P = 0.001 和 P = 0.001）。虽然实际 DLP 无显著差异（P = 0.52）。组 1 患者完全诊断的中位延迟时间为 7 天（四分位间距 2-10 天）。对于治疗决策所需的早期明确诊断的最廉价成像，对于怀疑关节突间骨折的年轻 LBP 运动员，建议首先进行放射性核素锝-99m 亚甲基二膦酸盐骨扫描，加做腰椎平面 SPECT 成像，仅当 SPECT 成像阳性提示存在活动性关节突间骨折时，加做薄层、有限 CT。两组患者的管理无显著差异（P = 0.47）。
在疑似关节突间骨折的年轻运动员 LBP 患者的初始评估中，混合成像应优于单纯 SPECT 成像。
