实用骨科杂志
實用骨科雜誌
실용골과잡지
Journal of Practical Orthopaedics
2015年
9期
806-811
,共6页
熊伟%李兴%史德刚%黄克敏%苏少弟%冯彦林
熊偉%李興%史德剛%黃剋敏%囌少弟%馮彥林
웅위%리흥%사덕강%황극민%소소제%풍언림
99m Tc-MDP%SPECT/CT%股骨头缺血性坏死%骨代谢%定量分析
99m Tc-MDP%SPECT/CT%股骨頭缺血性壞死%骨代謝%定量分析
99m Tc-MDP%SPECT/CT%고골두결혈성배사%골대사%정량분석
99mTc-MDP%SPECT/CT%avascular necrosis of the femoral head%bone metabolism%quantitative analysis
目的：评价99m Tc-MDP SPECT/CT的定量分析方法，如局部放射性活性浓度（ activity concentration，ACC）、标准摄取值（ standardized uptake value，SUV）对于评估股骨头缺血性坏死（ avascular necrosis of the femoral head，ANFH）骨代谢的应用价值。方法27例ANFH患者共39髋，按FicatⅠ-Ⅳ期分别为6髋、18髋、9髋、6髋，19名健康者股骨头为健康组38髋，共5组。按照定量的SPECT/CT方案首先使用与患者相同的扫描程序与重建参数，通过一个标准的球形模拟品计算出一个从体素值到放射性示踪剂（ kBq/mL）的换算因子，它能被运用到患者的重建图像内换算出体内给定物体的ACC。常规扫描和图像重建后，利用感兴趣容积区划定技术进行靶区的划定体积（ volume-of-in-terest，VOIs），测定27例ANFH患者及19例健康者的股骨头的活性浓度、平均CT值（ Housfield，Hu）及股骨头病灶大小（cm3），通过标准摄取值的公式可获得患者股骨头的SUV值。结果5组ACC分别为（9.39±2.79）kBq/mL，（68.02±20.16）kBq/mL，（112.41±33.03）kBq/mL，（117.82±26.26）kBq/mL，（32.56±4.81）kBq/mL；SUV分别为（0.64±0.19），（4.61±1.33），（7.44±1.97），（7.80±2.03），（2.18±0.32）。5组之间的ACC以及SUV分别比较，其中Ⅲ期和Ⅳ期P﹥0.05，Ⅰ期和健康组P﹤0.05，其余组别分别P﹤0.001。5组Hu分别为（230.00±17.94），（363.06±129.75），（372.67±15.72），（369.83±32.40），（260.84±43.60）。其中Ⅰ期与健康组P﹥0.05，Ⅱ期、Ⅲ期、Ⅳ期三组之间P﹥0.05，其余各组间P﹤0.01。ANFH四组的病灶大小分别为（6.41±2.27）cm3，（10.79±5.82） cm3，（21.94±8.02）cm3，（26.97±5.39）cm3。其中Ⅰ期与Ⅱ期、Ⅲ期与Ⅳ期P﹥0.05，其余各组间的P﹤0.001。AN-FH四组的ACC、SUV及病灶大小之间的相关性分析结果：ACC与病灶大小之间r=0.856，P﹤0.001；SUV与病灶大小之间r=0.851，P﹤0.001。结论利用SPECT/CT的定量分析方法研究得出，ACC以及表达的SUV值与ANFH的分期及其病理变化有着内在的关系，它能反映病变骨组织的骨代谢水平，较早预测病变骨组织的修复和愈合能力，从而评估现阶段治疗的有效性并及时选择适宜的治疗方案。
目的：評價99m Tc-MDP SPECT/CT的定量分析方法，如跼部放射性活性濃度（ activity concentration，ACC）、標準攝取值（ standardized uptake value，SUV）對于評估股骨頭缺血性壞死（ avascular necrosis of the femoral head，ANFH）骨代謝的應用價值。方法27例ANFH患者共39髖，按FicatⅠ-Ⅳ期分彆為6髖、18髖、9髖、6髖，19名健康者股骨頭為健康組38髖，共5組。按照定量的SPECT/CT方案首先使用與患者相同的掃描程序與重建參數，通過一箇標準的毬形模擬品計算齣一箇從體素值到放射性示蹤劑（ kBq/mL）的換算因子，它能被運用到患者的重建圖像內換算齣體內給定物體的ACC。常規掃描和圖像重建後，利用感興趣容積區劃定技術進行靶區的劃定體積（ volume-of-in-terest，VOIs），測定27例ANFH患者及19例健康者的股骨頭的活性濃度、平均CT值（ Housfield，Hu）及股骨頭病竈大小（cm3），通過標準攝取值的公式可穫得患者股骨頭的SUV值。結果5組ACC分彆為（9.39±2.79）kBq/mL，（68.02±20.16）kBq/mL，（112.41±33.03）kBq/mL，（117.82±26.26）kBq/mL，（32.56±4.81）kBq/mL；SUV分彆為（0.64±0.19），（4.61±1.33），（7.44±1.97），（7.80±2.03），（2.18±0.32）。5組之間的ACC以及SUV分彆比較，其中Ⅲ期和Ⅳ期P﹥0.05，Ⅰ期和健康組P﹤0.05，其餘組彆分彆P﹤0.001。5組Hu分彆為（230.00±17.94），（363.06±129.75），（372.67±15.72），（369.83±32.40），（260.84±43.60）。其中Ⅰ期與健康組P﹥0.05，Ⅱ期、Ⅲ期、Ⅳ期三組之間P﹥0.05，其餘各組間P﹤0.01。ANFH四組的病竈大小分彆為（6.41±2.27）cm3，（10.79±5.82） cm3，（21.94±8.02）cm3，（26.97±5.39）cm3。其中Ⅰ期與Ⅱ期、Ⅲ期與Ⅳ期P﹥0.05，其餘各組間的P﹤0.001。AN-FH四組的ACC、SUV及病竈大小之間的相關性分析結果：ACC與病竈大小之間r=0.856，P﹤0.001；SUV與病竈大小之間r=0.851，P﹤0.001。結論利用SPECT/CT的定量分析方法研究得齣，ACC以及錶達的SUV值與ANFH的分期及其病理變化有著內在的關繫，它能反映病變骨組織的骨代謝水平，較早預測病變骨組織的脩複和愈閤能力，從而評估現階段治療的有效性併及時選擇適宜的治療方案。
목적：평개99m Tc-MDP SPECT/CT적정량분석방법，여국부방사성활성농도（ activity concentration，ACC）、표준섭취치（ standardized uptake value，SUV）대우평고고골두결혈성배사（ avascular necrosis of the femoral head，ANFH）골대사적응용개치。방법27례ANFH환자공39관，안FicatⅠ-Ⅳ기분별위6관、18관、9관、6관，19명건강자고골두위건강조38관，공5조。안조정량적SPECT/CT방안수선사용여환자상동적소묘정서여중건삼수，통과일개표준적구형모의품계산출일개종체소치도방사성시종제（ kBq/mL）적환산인자，타능피운용도환자적중건도상내환산출체내급정물체적ACC。상규소묘화도상중건후，이용감흥취용적구화정기술진행파구적화정체적（ volume-of-in-terest，VOIs），측정27례ANFH환자급19례건강자적고골두적활성농도、평균CT치（ Housfield，Hu）급고골두병조대소（cm3），통과표준섭취치적공식가획득환자고골두적SUV치。결과5조ACC분별위（9.39±2.79）kBq/mL，（68.02±20.16）kBq/mL，（112.41±33.03）kBq/mL，（117.82±26.26）kBq/mL，（32.56±4.81）kBq/mL；SUV분별위（0.64±0.19），（4.61±1.33），（7.44±1.97），（7.80±2.03），（2.18±0.32）。5조지간적ACC이급SUV분별비교，기중Ⅲ기화Ⅳ기P﹥0.05，Ⅰ기화건강조P﹤0.05，기여조별분별P﹤0.001。5조Hu분별위（230.00±17.94），（363.06±129.75），（372.67±15.72），（369.83±32.40），（260.84±43.60）。기중Ⅰ기여건강조P﹥0.05，Ⅱ기、Ⅲ기、Ⅳ기삼조지간P﹥0.05，기여각조간P﹤0.01。ANFH사조적병조대소분별위（6.41±2.27）cm3，（10.79±5.82） cm3，（21.94±8.02）cm3，（26.97±5.39）cm3。기중Ⅰ기여Ⅱ기、Ⅲ기여Ⅳ기P﹥0.05，기여각조간적P﹤0.001。AN-FH사조적ACC、SUV급병조대소지간적상관성분석결과：ACC여병조대소지간r=0.856，P﹤0.001；SUV여병조대소지간r=0.851，P﹤0.001。결론이용SPECT/CT적정량분석방법연구득출，ACC이급표체적SUV치여ANFH적분기급기병리변화유착내재적관계，타능반영병변골조직적골대사수평，교조예측병변골조직적수복화유합능력，종이평고현계단치료적유효성병급시선택괄의적치료방안。
Objective To analyze the pathophysiological changes of avascular necrosis of the femoral head( ANFH)in each stage and prognosis using the quantitative analysis methods of 99mTc-MDP SPECT/CT. And to evaluate the value in measuring the bone metabolism of Avascular necrosis of the femoral head . Methods 2 7 patients( mean age 4 3 . 6 2 ± 14. 63 years)with 39 hips of ANFH,according to the Ficat staging system were divided intoⅠ-Ⅳ stages,there were 6,18, 9,6 hips,respectively. 19 healthy people(mean age 43. 74 ± 11. 83years)with 38 healthy femoral head as a health group. Ac-cording to the quantitative SPECT/CT system,a SPECT/CT scan of phantoms was performed with the same scanner and recon-struction parameters of patients to calculate a conversion factor from voxel values to radiotracer concentrations( kBq/ml). We applied image reconstruction of patients to calculate the activity concentration of a given object in the body. After conventional SPECT/CT scanning and image reconstruction,the volume-of-interest of image reconstruction was performed with the vol-ume-of-interest technology. The activity concentration,Hu,lesion size of the femoral head of 26 ANFH patients and 19 healthy people were determined. We obtained the SUV values of the femoral head of the patients through the formula of SUV. The average activity of 99mTc-MDP were 878. 19 ± 116. 32MBq,SPECT/CT was performed 3 h after intravenous injection.Results Five groups of ACC(kBq/ml)were 9. 39 ± 2. 79,68. 02 ± 20. 16,112. 41 ± 33. 03,117. 82 ± 26. 26,32. 56 ± 4. 81. Additional five groups of SUV were 0. 64 ± 0. 19,4. 61 ± 1. 33,7. 44 ± 1. 97,7. 80 ± 2. 03,2. 18 ± 0. 32. ACC and SUV be-tween five groups were compared respectively,with stageⅢandⅣP﹥0. 05,stageⅠand the healthy group P﹤0. 05,the re-maining groups P﹤0. 001 respectively. Five groups of Hu were 230. 00 ± 17. 94,363. 06 ± 129. 75,372. 67 ± 15. 72,369. 83 ± 32.40,260.84±43.60.Among them,stage Ⅰ and the healthy group(P﹥0.05),stage Ⅱ,Ⅲ and Ⅳ groups had nostatistic difference(P﹥0. 05). Stage Ⅰ,the healthy group had no statistic difference compared with stage Ⅳ(P﹤0. 05),the rest of the groups P﹤0. 001. The lesion size(cm3)of 4 groups of ANFH were 6. 41 ± 2. 27,10. 79 ± 5. 82,21. 94 ± 8. 02,26. 97 ± 5. 39,among them stageⅠandⅡ,ⅢandⅣP﹥0. 05,among other groups P﹤0. 001. Analysis of ACC,SUV and lesion size among 4 groups of ANFH showed that ACC and lesion size r=0. 856,P﹤0. 001,SUV and lesion size r=0. 851,P﹤0. 001. Conclusion The technology of the quantitative SPECT/CT has the value of early diagnosis for Ficat I ANFH,it can make up for the shortcomings of the traditional bone scintigraphy. Through evaluating ACC and SUV values with the quantitative analysis technique of SPECT/CT. There is an inherent relationship between the stages of ANFH and pathological changes and ACC and SUV values. It can instantly reflect the every stage level of bone metabolism of the bone tissue. In the process of treatment,it is beneficial for earlier forecast the lesion repairment and healing in bone tissue lesions to monitor the level of bone metabolism of the bone tissue regularly. So as to assess the effectiveness of treatment and provide some reference value for timely select appro-priate treatment options.
