The Clinical Value Of ^99mTc-MDP Bone Scan In Postmenopausal Women With Osteoporotic Thoracolumbar Vertebral Fractures

Objective:To assess the clinical value of 99 m Tc-MDP SPECT/CT bone scan imaging by semi-quantitative analysis indexes for osteoporotic thoracolumbar vertebral fractures in postmenopausal women.Methods:Eighty-one postmenopausal women patients with back pain,diagnosed and treated in our hospital from November 2012 to October 2016,were enrolled in this retrospective study.Inclusion criteria: the dual-energy X-ray absorptiometry assessment（DXA）evaluate the bone mineral density（BMD）for the diagnosis of osteoporosis;the X-ray or MRI confirmed the thoracolumbar vertebral compression fractures.Exclusion criteria:1.the pathological vertebral compression fractures caused by organic lesion including cancer,inflammation,tuberculosis;2.the patients with severe cardiopulmonary disease which interferes the treatment method;3.The laboratory indicators of calcium,phosphorus and parathyroid hormone（PTH）are abnormal;4.The patients do not receive the standardized treatment.All patients with 99 m Tc-MDP whole body bone imaging were analyzed,including the extent and location of radioactive uptake.All the patients were diagnosed as osteoporotic thoracolumbar vertebral compression fractures.All the patients underwent 99 m Tc-MDP SPECT/CT bone imaging,and application ROI techniques repeatedly was used to draw the sagittal imaging site of the regional uptake in regions of interest（ROI）,recording the number radioactivecountings of lesions（T）and adjacent normal vertebral sagittal imaging（NT）,then calculating the T/NT ratio.The patients were divided into two groups.One group was treated by vertebroplasty or kyphoplasty after^99mTc-MDP SPECT/CT bone imaging,and the other group was treated with conservative treatment.The T/NT ratio of the two groups was statistically analyzed.Results:1.All 81 patients were detected including 180 thoracolumbar vertebral fractures.It is the most common vertebrae fracture that the twelfth thoracic vertebrae,which is a total of 33cases（18.53%,33/180）;the first lumbar vertebra which is a total of 26 cases 26（14.60%,26/180）;and the proportion was 11.23%,10.11% 8.42% respectively that the second,third lumbar vertebrae and the eleventh thoracic vertebrae.In addition,some other concurrent lesions which are absent in X-ray or MRI was find by SPECT/CT,for example rib fracture（29cases）,vertebral body attachment fracture（2cases）,sacrum fracture（2cases）and pubic fracture（2cases）.2.One hundred and ten vertebral fractures were treated by vertebroplasty or kyphoplasty after 99 m Tc-MDP SPECT/CT bone imaging,and seventy vertebral fractures were treated with conservative treatment.The T/NT ratio of fractures were 2.44±0.84 and 1.0 4±0.14,respectively（P<0.05）.The T/NT ratio of 29 vertebral compression fractures was less than 1.3.In this study,the value of Kappa is 0.66 about the consistency of 99 m Tc-MDP bone imaging and MRI in differentiating the old and fresh vertebral fractures in postmenopausal women.Conclusions:1.Bone imaging can provide some relevant information for the treatment of osteoporotic vertebral fractures,and the consistency of bone imaging and MRI is good in differentiating the old and fresh vertebral fractures in postmenopausal women.2.Bone imaging can be used to diagnose the whole body fracture,and the twelfth thoracic vertebrae and the first lumbar vertebrae are the most common lesions for the osteoporotic vertebral compression fractures in postmenopausal women.