Ryoo Hyun Gee, Lee Won Woo, Kim Ji Young, Kong Eunjung, Choi Woo Hee, Yoon Joon-Kee
1Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 South Korea.
2Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, South Korea.
Nucl Med Mol Imaging. 2019 Aug;53(4):287-295. doi: 10.1007/s13139-019-00600-2. Epub 2019 Jun 22.
Bone single-photon emission computed tomography/computed tomography (SPECT/CT) has been widely used for evaluation of femoral head viability in patients with femoral neck fracture. The current study aimed to investigate utility of standardized uptake value (SUV) from quantitative bone SPECT/CT for assessment of femoral head viability.
From March 2015 to November 2018, quantitative bone SPECT/CT was performed in 9 patients with non-viable femoral head post femoral neck fracture and in 31 controls. Maximum (SUVmax), mean (SUVmean), and minimum standardized uptake values (SUVmin) were measured over femoral head and neck. Mann-Whitney test with Bonferroni correction was used to compare SUVs of ipsilateral and contralateral femurs from femoral neck fracture patients with those of control femurs.
As for femoral head viability, SUVmax and SUVmean were not significantly decreased in non-viable femoral heads compared to those in controls. Only the SUVmin was significantly reduced in non-viable femoral heads (mean ± standard deviation, 0.57 ± 0.38) than in controls (0.95 ± 0.26, = 0.006) and contralateral femoral heads (1.36 ± 0.59, = 0.008). The cutoff SUVmin of 0.61 (g/mL) yielded a sensitivity of 77.8% and specificity of 87.1% for detection of non-viable femoral heads ( = 0.006). Contralateral femoral necks of the femoral neck fracture patients showed significantly higher SUVmean and SUVmin (3.17 ± 1.20 and 1.64 ± 0.63) than those of controls (2.32 ± 0.53 and 1.04 ± 0.27; = 0.021 and = 0.002, respectively), which seemed to reflect weight bearing effect or metabolic derangement.
The non-viable femoral heads from the femoral neck fracture showed significantly reduced SUVmin. Quantitative bone SPECT/CT holds promise for objective evaluation of femoral head viability.
骨单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）已广泛用于评估股骨颈骨折患者股骨头的存活情况。本研究旨在探讨定量骨SPECT/CT的标准化摄取值（SUV）在评估股骨头存活情况中的作用。
2015年3月至2018年11月，对9例股骨颈骨折后股骨头坏死患者和31例对照者进行了定量骨SPECT/CT检查。测量股骨头和股骨颈的最大（SUVmax）、平均（SUVmean）和最小标准化摄取值（SUVmin）。采用Bonferroni校正的Mann-Whitney检验比较股骨颈骨折患者患侧和对侧股骨的SUV与对照股骨的SUV。
关于股骨头存活情况，与对照组相比，坏死股骨头的SUVmax和SUVmean无显著降低。仅坏死股骨头的SUVmin显著低于对照组（均值±标准差，0.57±0.38）（对照组为0.95±0.26，P = 0.006）和对侧股骨头（1.36±0.5,9，P = 0.008）。SUVmin截断值为0.61（g/mL）时，检测坏死股骨头的灵敏度为77.8%，特异性为87.1%（P = 0.006）。股骨颈骨折患者的对侧股骨颈显示SUVmean和SUVmin显著高于对照组（分别为3.17±1.20和1.64±0.63）（对照组为2.32±0.53和1.04±0.27；P分别为0.021和0.002），这似乎反映了负重效应或代谢紊乱。
股骨颈骨折导致的坏死股骨头显示SUVmin显著降低。定量骨SPECT/CT有望用于客观评估股骨头存活情况。
