The Value Of SPEVT/CT In The Diagnosis Of Osteoporotic Multiple Vertebral Fractures

OBJECTIVETo evaluate the value of SPECT/CT in the differential diagnosis of fresh and old osteoporotic vertebral fractures.To calculate the critical value of semi-quantitative analysis in the differential diagnosis of fresh and old osteoporotic vertebral fractures.To study the correlation between the degree of concentration of SPECT/CT and 3 factors including the vertebral fracture time,vertebral fracture segment,and patient age in fresh and old osteoporotic vertebral fracture respectively.METHODSA retrospective study was performed on 35 osreoporotic vertebral patients in our hospital.Their bone mineral density were all less than-2.5.MRI and SPECT/CT examinations were performed within 5 days before operation.All patients were followed up after operation,and the final clinical diagnosis results were obtained.Based on the clinical final diagnosis results,the diagnostic efficiency of MRI and SPECT/CT were calculated respectively.Chi square test was used to compare the diagnostic efficiency of the two methods for the diagnosis of fresh and old vertebral fractures.The consistency of MRI and SPECT/CT diagnostic results was analyzed by Kappa test.Semi-quantitative analysis of the concentration of SPECT/CT in fresh and old vertebral body was performed by T/N.The difference of T/N concentration between fresh and old vertebral fracture group was compared by independent sample t test.The ROC curve of Tmax/N and Tmean/N was drawn based on the final diagnosis result by SPSS17.0.According to the ROC curve,we identify the critical value of Tmax/N and Tmean/N respectively in the differential diagnosis of fresh and old vertebral fractures.The study of the correlation of the degree of concentration of SPECT/CT in fresh and old osteoporotic vertebral fracture was performed respectively from aspects of the vertebral fracture time,vertebral fracture segment and patient's age.The aim is to find out the related factors of T/N value of fresh and old vertebral fractures respectively.RESULTS98 segments of fresh and old fracture vertebrae were found in 35 patients.According to clinical symptom,image examination,postoperative follow-up and pain score,there were 51 segments of fresh fracture vertebral body(acute and subacute fracture vertebral body)and 47 segments of old fracture vertebrae diagnosed by clinican finally.1.Based on the clinical final diagnosis results,the sensitivity of SPECT/CT and MRI were 88.2% and 86.3%(c2=0.088,P>0.05),the specificity of them were 85.1% and 89.4%(c2=0.382,P>0.05),the accuracy of them were 86.7% and 97.8%,(c2=0.046,P>0.05),the positive predictive values of them were 86.5% and 89.8%(c2=0.256,P> 0.05),and the negative predictive value of them were 87% and 85.7%%(c2=0.031,P>0.05).All of above had no significant differences.2.The results of SPECT/CT and MRI were tested by Kappa consistency test,Kappa=0.776>0.75,P<0.001,suggesting that the results of the two methods were in good consistency.3.The Tmax/N values of fresh vertebral fracture segments and old vertebral fracture segments were analyzed by independent sample t test between the two groups,t=4.78 and P<0.05,indicating that the Tmax/N values between the two groups were statistically significant.The Tmean/N values of fresh vertebral fracture segments and old vertebral fracture segments were analyzed by independent sample t test between the two groups,t=3.87 and P<0.05,indicating that the Tmean/N values between the two groups were statistically significant.4.Based on the clinical final diagnosis result,the ROC curve of Tmax/N and Tmean/N was drawn by SPSS17.0.According to the ROC curve,the critical value of Tmax/N in the differential diagnosis of fresh and old vertebral fractures was 2.01.The critical value of Tmean/N in the differential diagnosis of fresh and old vertebral fractures was 1.53.5.In the fresh vertebral fracture growp,the correlation between Tmax/N value,Tmean/N value and 3 factors including fracture time,fracture segment and patient's age were analyzed by Spearman non parametric correlation coefficient.The correlation between Tmax/N and fracture time was statistically significant(P<0.05),and the correlation coefficient was 0.335.The correlation between Tmean/N and fracture time was statistically significant(P<0.05),and the correlation coefficient was 0.301.6.In the old vertebral fracture growp,the correlation between Tmax/N value,Tmean/N value and 3 factors including fracture time,fracture segment and patient's age were analyzed by Spearman non parametric correlation coefficient.The correlation between Tmax/N and fracture time was statistically significant(P<0.05),and the correlation coefficient was-0.314.The correlation between the Tmean/N of the non responsible vertebral body and patient's age was statistically significant(P<0.05),and the correlation coefficient was 0.321.CONCLUSION1.The diagnostic results of SPECT/CT and MRI were in good consistency.SPECT/CT could be used as a supplementary or alternative diagnostic method for MRI.2.The critical value was determined by the ROC curve,and it had high sensitivity for the differential diagnosis of fresh and old fractures.3.The Tmax/N and Tmean/N of the fresh fracture vertebral body were associated with the fracture time.The measurement of T/N value of fresh fracture vertebral was significant to conjecture the time of fresh vertebral fracture.4.The Tmax/N of the old fracture vertebral body was correlated with the fracture time.The measurement of Tmax/N value of old fracture vertebral was significant to conjecture the time of old vertebral fracture.and the Tmean/N was related to the age of the patient.The age of patients should be taken into account in the differential diagnosis of fresh and old vertebral fractures.