Clinical problems of single photon emission computed tomography/CT applied in accurate diagnosis and location of spinal surgery

doi:10.3969/j.issn.2095-4344.1129

Abstract

Abstract:

BACKGROUND: MRI has some limitations in the accurate diagnosis and localization of some diseases in spine surgery. With the wide application of single photon emission computed tomography/CT in spine surgery, it has unique value and advantages in clinical diagnosis and localization.

OBJECTIVE: To evaluate the application value of single photon emission computed tomography/CT in accurate diagnosis and location of spine surgery.

METHODS: The imaging examination of single photon emission computed tomography/CT and X-ray, CT and MRI of the patients at Eastern Branch of Qingdao Municipal Hospital from January to December 2017 were compared. The advantages and problems of single photon emission computed tomography/CT in the diagnosis and localization of lumbar facet joint disorder, thoracolumbar vertebral compression fracture, postoperative lumbar and back pain, and spinal malignant tumors were summarized and analyzed.

RESULTS AND CONCLUSION: (1) Due to high sensitivity, single photon emission computed tomography/CT has a unique advantage in lumbar facet joint disorder, postoperative lumbar back pain, and early diagnosis of spinal malignant tumors. (2) However, there is a false positive rate in the diagnosis of thoracolumbar vertebral compression fracture, but there is a false negative rate in the diagnosis of spinal tumors with osteolytic destruction. (3) Single photon emission computed tomography/CT is of great value in the clinical application of precise diagnosis and location in spine surgery.

Key words: Tomography, Emission-Computed, Single-Photon, Tissue Engineering

CLC Number:

R445

Lin Yujiang, Lin Yong, Wang Dechun, Yang Limin, Wei Jianwei. Clinical problems of single photon emission computed tomography/CT applied in accurate diagnosis and location of spinal surgery[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(12): 1915-1920.

Figures/Tables 6

单光子发射计算机断层显像/CT检查结果有3节椎体出现假阴性，分析考虑与椎体压缩骨折所处时期有关。临床上胸腰椎压缩性骨折的演变过程大体分为3个时期：新鲜骨折期、骨折愈合修复期以及骨折愈合或不愈合期。老年性骨质疏松性胸腰椎体压缩骨折往往是多节段、多阶段并存的。单光子发射计算机断层显像/CT病灶浓聚程度与成骨活性成正比，骨折早期即出现血流与成骨细胞活动增加，一般在骨折后6-72 h内即可在血流相、血池相以及延迟骨相中见到放射性浓集区域，而这3例患者皆为受伤时间较久，可能处于胸腰椎体压缩骨折的第3阶段，病灶陈旧，代谢缓慢甚至终止，显像剂吸收相对减少或仅有少量吸收浓聚，特别是出现骨折不愈合时，椎体出现局部骨质吸收，液化，MRI可表现为T1WI 高信号，而单光子发射计算机断层显像/CT无特异性表现，表现为阴性[14]。而3例单光子发射计算机断层显像/CT检查假阳性的结果，经仔细研究后发现，其均为椎体陈旧性压缩骨折伴有严重的骨质增生，因而单光子发射计算机断层显像/CT出现放射性浓聚的假阳性表现。因此单光子发射计算机断层显像/CT灵敏度高，相对的，其特异性就不强，炎症、创伤、手术或严重的骨质增生或者退行性变等骨代谢异常会造成其结果的假阳性[15]。 3 术后腰背部疼痛 Postoperative lumbar and back pain 腰背部疼痛是腰椎术后最常见的并发症，造成术后腰背痛的原因大体可分为4个方面：①软组织源性：术中对软组织的剥离、破坏以及术后腰部肌肉瘢痕化、纤维化，失去原有的弹性，术后腰背肌持续呈紧张状态，使小血管痉挛，局部供氧不足，代谢产物局部积累刺激而形成损伤性炎症造成腰背部疼痛；②腰椎间盘源性：腰椎间盘突出复发、术后粘连、术后椎间隙感染以及因为椎板或髓核切除，导致椎间高度变化，脊柱生物力学随之改变，腰椎稳定性下降，从而导致腰背部疼痛；③关节突关节源性：腰椎术后关节突平衡系统被打破,机械应力分布发生变化，应力集中于椎体后部，从而引起关节突关节内压力增高,关节间发生损伤，进而发生滑膜炎、关节间隙狭窄等一系列退行性病变，导致腰背部疼痛。另外，脊神经被内侧支部分小的分支进入腰椎关节突关节的关节囊上，其对脊柱负载承受的高张力及扭转应力比较敏感, 导致自发激活、放电等相关神经源性疼痛；④内植物源性：腰椎椎弓根螺钉置入术后，与周围软组织接触、摩擦，产生电解，代谢产物积累产生炎性刺激，从而造成腰背部疼痛。另外，部分重症骨质疏松的患者术后会因为椎弓根螺钉松动、移位而产生腰背痛[16-20]。 2017年青岛市市立医院东院共收治了58例术后半年至2年出现腰背部疼痛的患者，其中有3例为椎间孔镜下椎间盘切除术后，经CT、MRI检查确诊为腰椎间盘突出复发(腰椎间盘源性)，单光子发射计算机断层显像/CT检查为阴性，给予再次手术切除突出的椎间盘。有22例CT及MRI未发现明显异常，单光子发射计算机断层显像/CT检查发现腰椎关节突关节有放射性浓聚(关节突关节源性)，治疗方案为腰椎关节突射频消融/封闭术，术后患者腰背痛症状明显缓解。有18例为腰椎椎弓根螺钉内固定术后腰背部疼痛(内植物源性)，其中有8例CT、MRI以及单光子发射计算机断层显像/CT检查都显示为内固定物松动，给予手术取出内固定物；其余10例CT、MRI检查显示阴性，单光子发射计算机断层显像/CT显示内固定物周围有放射性浓聚，考虑为内植物产生的炎性刺激，给予射频消融/封闭治疗，术后患者腰背痛即可缓解。最后15例CT、MRI以及单光子发射计算机断层显像/CT检查全部未发现明显异常，考虑软组织源性腰背痛，治疗方案为康复理疗/封闭，经治疗后，患者腰背部疼痛症状全部有明显缓解，见表3。"

4 脊柱恶性肿瘤 Spinal malignant tumors 脊柱是肿瘤的好发部位之一，转移性肿瘤多见于前列腺癌、乳腺癌、肺癌等。肿瘤细胞通过血行播散或邻近侵犯等途径累及到脊柱，在局部产生一系列的破骨与成骨反应的过程。单光子发射计算机断层显像骨显像凭借其灵敏性高，一次成像就能反映全身骨骼情况的优势，成为恶性肿瘤脊柱转移的首选筛查手段。单光子发射计算机断层显像骨显像比X射线、CT能早3-6个月发现肿瘤转移病灶。但是单光子发射计算机断层显像骨显像因为分辨率低、图像模糊，特异性及精准定位不如CT及MRI，而且单光子发射计算机断层显像骨显像由于腰椎退行性变、炎症、结核、骨折等均可导致局部放射性浓聚，出现假阳性，同时有些肿瘤转移病灶局部骨质破坏快，新生骨慢，显影剂在局部沉积慢，又会出现假阴性。单光子发射计算机断层显像/CT是结合了单光子发射计算机断层显像与CT的2种特性，既具有单光子发射计算机断层显像的早期诊断、高灵敏性等优点，又具有CT的高分辨率、图像清晰等特点，实现了功能代谢显像与解剖结构成像的完美融合，明显提高了诊断的特异性及准确性，在脊柱转移肿瘤的诊断方面具有较高的增益价值[24-25]。青岛市市立医院东院2017年曾选择24例入院诊断为脊柱肿瘤的患者，均给予MRI及单光子发射计算机断层显像/CT检查，最终穿刺活检或者手术取病灶组织送检病理明确诊断，比较分析单光子发射计算机断层显像/CT对脊柱转移肿瘤诊断的准确性。MRI检查结果为24例均为脊柱恶性肿瘤；单光子发射计算机断层显像/CT检查结果为23例为脊柱恶性肿瘤，1例为胸椎压缩性骨折。最终病理结果诊断为23例为脊柱恶性肿瘤，剩余1例为腰椎椎体血管瘤合并压缩性骨折，MRI及单光子发射计算机断层显像/CT对此例的检查结果均为脊柱恶性肿瘤，呈现假阳性，见表4。"

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