The Diagnostic Value of 99Tcm-MDP Bone Scintigraphy in Localizing Fresh Lesions of Osteoporotic Thoracolumbra Fractures
Objective To evaluate the diagnostic value of 99Tcm-MDP bone scintigraphy and its semi-quantitative analysis parameters in the diagnosis of fresh lesions of osteoporotic thoracolumbar fracture(OTLF).Methods The clinical datasets of 46 patients with OTLF who received 99Tcm-MDP bone scintigraphy and MRI due to low back pain caused by daily activities or minor trauma from February,2021 to June,2023 were retrospectively analyzed.The fractured vertebrae(T)and adjacent normal vertebrae(NT)in SPECT/CT tomofusion images were delineated by an image post-processing system to obtain the semi-quantitative parameters of bone imaging(T/NT value).With MRI results as the gold standard,the area under the ROC curve(AUC),Youden index,sensitivity,specificity,and the best cut-off value were obtained by receiver operating characteristic(ROC)curve analysis.Further,the best cut-off value was used as a reference index to distinguish fresh fracture lesions,and the number of OTLF lesions was counted again.The Kappa test and paired Chi-square test(McNemar test)were performed to compare the consistency and difference between the visual analysis and semi-quantitative analysis of bone scintigraphy and MRI in the diagnosis of OTLF.Results A total of 112 OTLF lesions were included in the analysis.Firstly,the AUC values of Tmax/NTmax and Tmax/NTmean of two semi-quantitative parameters of bone scintigraphy obtained by ROC curve analysis were as follows:0.923(95％CI 0.871-0.975,P＜0.001)and 0.941(95％CI 0.871-0.975,P＜0.001),indicating that the difference was statistically significant(P=0.025).The Tmax/NTmean ratio showed a better detection efficiency in OTLF patients,and the corresponding cut-off value was 2.64.The Youden index,sensitivity,and specificity of the two methods were 0.808,85.3％,and 95.5％respectively.Secondly,the semi-quantitative analysis method of bone scintigraphy reference index of OTLF lesions detected with MRI in the diagnosis of consistency(Kappa=0.782,P＜0.001)were significantly higher than those of bone scintigraphy for visual analysis(Kappa=0.578,P＜0.001),The differences in the positive detection rates of all methods were statistically significant(P＜0.05).Finally,it was also found that the ribs,vertebral body bone scintigraphy accessories,four limbs,shoulder blades,and pubic place outside vertebral fractures.Conclusion The visual analysis and semi-quantitative analysis of 99Tcm-MDP bone scintigraphy have important clinical values in the diagnosis and clinical treatment of fresh OTLF lesions.
Bone scintigraphyMRIOsteoporotic thoracolumbar fractureDiagnostic valueROC curve
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