Cuvilliers Cécile, Palard-Novello Xavier, Pontoizeau Clémence, Meneret Pierre, Devillers Anne, Le Jeune Florence, Girard Antoine
Nuclear Medicine Department, Centre Eugène Marquis, Rennes, France.
University of Rennes 1, Rennes, France.
Front Med (Lausanne). 2021 Mar 5;8:634419. doi: 10.3389/fmed.2021.634419. eCollection 2021.
To evaluate the interest of adding a bloodpool SPECT/CT to standard three-phase bone scintigraphy (BS) for etiological diagnosis of subacute and chronic lower extremity pains. We prospectively included patients addressed for pain of lower extremities lasting for at least 6 weeks, without previous surgery. They underwent a standard three-phase BS including late phase SPECT/CT, modified with an additional bloodpool SPECT/CT acquisition. Two independent physicians interpreted the images provided by both protocols. Diagnostic conclusion, diagnostic confidence, and interrater agreements were compared. One hundred and eighteen lower extremities from 113 patients were analyzed (71 men, median age of 53 years). Adding bloodpool SPECT/CT to standard three-phase BS changed diagnostic conclusions in 24.6% (29/118) of lower extremities. The modified protocol revealed at least one diagnostic conclusion explaining the pain in 89% of extremities, rather than 83.1% with the standard protocol ( = 0.02). Tendinopathies were diagnosed in 12.7% of lower extremities, rather than 4.2% with standard BS ( = 0.002). Adding bloodpool SPECT/CT substantially increased overall confidence of each reader ( < 0.001). Inter-reader agreement was not significantly impacted. Adding bloodpool SPECT/CT to standard three-phase BS impacted diagnostic conclusion in a quarter of the patients with painful lower extremities, notably by revealing significantly more tendonitis.
评估在标准三相骨闪烁显像（BS）基础上增加血池单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）对亚急性和慢性下肢疼痛进行病因诊断的价值。我们前瞻性纳入了因下肢疼痛就诊且持续至少6周、未接受过手术的患者。他们接受了标准三相BS检查，包括晚期SPECT/CT，并额外增加了血池SPECT/CT采集。两名独立医生对两种检查方案提供的图像进行解读。比较诊断结论、诊断信心和评分者间一致性。分析了113例患者的118条下肢（71例男性，中位年龄53岁）。在标准三相BS基础上增加血池SPECT/CT使24.6%（29/118）的下肢诊断结论发生改变。改良方案在89%的下肢中揭示了至少一个可解释疼痛的诊断结论，而标准方案为83.1%（P = 0.02）。12.7%的下肢诊断为肌腱病，而标准BS为4.2%（P = 0.002）。增加血池SPECT/CT显著提高了每位阅片者的总体信心（P < 0.001）。阅片者间一致性未受到显著影响。在标准三相BS基础上增加血池SPECT/CT对四分之一的下肢疼痛患者的诊断结论产生了影响，特别是显著发现了更多的肌腱炎。
