^(99m)Tc-MDP SPECT/CT对于股骨头缺血性坏死骨代谢的定量分析研究  

99mTc- MDP SPECT / CT for Quantitative Analyses of the Bone Metabolism of Avascular Necrosis of the Femoral Head

作　　者：熊伟[1,2] 李兴[1] 史德刚[2] 黄克敏[3] 苏少弟[3] 冯彦林[3] 

机构地区：[1]贵阳医学院附属医院医学影像科,贵州贵阳550004 [2]佛山市第一人民医院肿瘤靶向介入科,广东佛山528000 [3]佛山市第一人民医院核医学科,广东佛山528000

出　　处：《实用骨科杂志》2015年第9期806-811,共6页Journal of Practical Orthopaedics

基　　金：广东省科技厅资助项目(2004B3600102);佛山市科技局资助项目(2011AA100141)

摘　　要：目的评价99mTc-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(k Bq/m L)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-interest,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)k Bq/m L,(68.02±20.16)k Bq/m L,(112.41±33.03)k Bq/m L,(117.82±26.26)k Bq/m L,(32.56±4.81)k Bq/m L;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。ANFH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�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,aceording to the Fieat staging system were divided into I - 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） were9.39±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 stage Ⅲ and IV P 〉0.05 ,stage I and 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 grou

关 键 词：99MTC-MDP SPECT/CT 股骨头缺血性坏死 骨代谢 定量分析 

分 类 号：R681.8[医药卫生—骨科学]