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Original research
Laetitia IMBERT
CHRU Nancy
Corresponding Author
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This study aimed to determine whether absolute quantification obtained with a high-speed CZT SPECT/CT system provides consistent results on phantom and in bone scintigraphy-based longitudinal monitoring of patients with vertebral fractures and/or fracture cascades.
Materials and Methods. SPECT images were reconstructed as recommended for clinical routine. Both image quality and accuracy of measured activity were evaluated using an IEC body phantom. The optimized reconstruction process was applied to routine ≤ 15 min 99mTc-HDP SPECT spine recordings, which had been previously acquired from 25 patients (74±12 years old) at both early (1.3±1.1 months) and late (5.2±2.3 months) stage assessments of an acute vertebral fracture of a traumatic and/or osteoporotic origin.
Results. A SPECT reconstruction with 32 equivalent iterations was used based on high levels of foci detectability in spheres as small as 0.6 mL in volume, and accuracy of measured activity, although the latter was affected by partial volume effect for spheres ≤ 5.8 mL.
SUVmax from patients’ intact T1 vertebrae, used as a reference, remained stable between 1st and 2nd SPECT recordings (5.7±1.1 vs. 5.8±1.1, p=0.76). SUVmax from the initially fractured vertebrae were 3-fold higher on 1st SPECT (21.0±8.5, p<0.001 vs. T1 SUVmax) and markedly decreased on 2nd SPECT (11.2±4.2, p<0.001 vs. 1st SPECT). Inverse changes in SUVmax were documented for newly compacted fractures apparent on the 2nd SPECT (1st SPECT: 7.4±2.0 vs. 2nd SPECT: 21.8±10.3, p=0.002) together with an increased bone density on CT (in mean Hounsfield Units: 121±28 vs.190±39, p=0.003). Rate of SUVmax > 7.5 was 98% (56/57) for measurements obtained in vertebrae fractured in the preceding 7-months, whereas this rate was only 4% for the reference intact vertebrae (2/50).
Conclusion. High-speed recordings with this CZT-SPECT/CT system provide reliable SUV measurements that may attest to longitudinal changes in vertebral bone metabolism and especially changes related to fracture healing or recurrence.
Keywords
CZT, SPECT, bone scintigraphy, vertebral fracture, standardized uptake value
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- Suppl.Fig.4.png
Supplemental Figure 4: Mean SUV (upper panel) and maximal SUV (lower panel) obtained from the bodies of intact (grey symbols) and fractured (black symbols) vertebrae and displayed according to the delay-time from the date of the fracture, as in Figure 2 (see the complete symbols description in the Figure 2 legend). These SUV mean and max are given here with log scales to better depict their distribution regarding the thresholds that provided the highest overall proportions of well classified separation between fractured and intact vertebrae on Receiver Operating Curves -i.e. 4.5 for SUV mean and 7.5 for SUV max. However, this proportion was higher with SUV max (94% (105/112) than with SUV mean (82% (92/112), p=0.001 on a McNemar test).
- Suppl.Fig.5.png
Supplemental Figure 5: Sagittal SPECT/CT images and MRI centered on the lumbar spine and recorded in a 70 year-old man with a history of L3 cementoplasty, two months previously. This SPECT/CT recording had been planned for a suspicion of new painful fractures. The SPECT images were initially displayed with a conventional scaling method according to the maximal voxel intensity and further visual adjustment, and a high uptake was observed mainly on the body of L5 (left panel), suggesting the potential benefit of an augmentation procedure targeted on L5. However, the physician in charge of the augmentation procedures found these images to be discordant, as compared with the lesions extending from L2 to L5 on an MRI recorded during the same period (right panel). In a second step, the scale of SPECT images was modified, with a maximum level set at 13 SUV, thus saturating the high uptake level from L5 and providing clear identification of the bone structures reaching a level ≥ 7.5 (median panel). On these new SPECT images, much more diffuse abnormalities were detected, extending from L2 to L5 and with vertebral SUVmax ranging from 10.5 to 31.5, in accordance with the observations provided by MRI.
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Original research
Laetitia IMBERT
CHRU Nancy
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 04 May, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Physical Medicine & Rehab
License:
This work is licensed under a CC BY 4.0 License. Read Full License
This study aimed to determine whether absolute quantification obtained with a high-speed CZT SPECT/CT system provides consistent results on phantom and in bone scintigraphy-based longitudinal monitoring of patients with vertebral fractures and/or fracture cascades.
Materials and Methods. SPECT images were reconstructed as recommended for clinical routine. Both image quality and accuracy of measured activity were evaluated using an IEC body phantom. The optimized reconstruction process was applied to routine ≤ 15 min 99mTc-HDP SPECT spine recordings, which had been previously acquired from 25 patients (74±12 years old) at both early (1.3±1.1 months) and late (5.2±2.3 months) stage assessments of an acute vertebral fracture of a traumatic and/or osteoporotic origin.
Results. A SPECT reconstruction with 32 equivalent iterations was used based on high levels of foci detectability in spheres as small as 0.6 mL in volume, and accuracy of measured activity, although the latter was affected by partial volume effect for spheres ≤ 5.8 mL.
SUVmax from patients’ intact T1 vertebrae, used as a reference, remained stable between 1st and 2nd SPECT recordings (5.7±1.1 vs. 5.8±1.1, p=0.76). SUVmax from the initially fractured vertebrae were 3-fold higher on 1st SPECT (21.0±8.5, p<0.001 vs. T1 SUVmax) and markedly decreased on 2nd SPECT (11.2±4.2, p<0.001 vs. 1st SPECT). Inverse changes in SUVmax were documented for newly compacted fractures apparent on the 2nd SPECT (1st SPECT: 7.4±2.0 vs. 2nd SPECT: 21.8±10.3, p=0.002) together with an increased bone density on CT (in mean Hounsfield Units: 121±28 vs.190±39, p=0.003). Rate of SUVmax > 7.5 was 98% (56/57) for measurements obtained in vertebrae fractured in the preceding 7-months, whereas this rate was only 4% for the reference intact vertebrae (2/50).
Conclusion. High-speed recordings with this CZT-SPECT/CT system provide reliable SUV measurements that may attest to longitudinal changes in vertebral bone metabolism and especially changes related to fracture healing or recurrence.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- Suppl.Fig.4.png
Supplemental Figure 4: Mean SUV (upper panel) and maximal SUV (lower panel) obtained from the bodies of intact (grey symbols) and fractured (black symbols) vertebrae and displayed according to the delay-time from the date of the fracture, as in Figure 2 (see the complete symbols description in the Figure 2 legend). These SUV mean and max are given here with log scales to better depict their distribution regarding the thresholds that provided the highest overall proportions of well classified separation between fractured and intact vertebrae on Receiver Operating Curves -i.e. 4.5 for SUV mean and 7.5 for SUV max. However, this proportion was higher with SUV max (94% (105/112) than with SUV mean (82% (92/112), p=0.001 on a McNemar test).
- Suppl.Fig.5.png
Supplemental Figure 5: Sagittal SPECT/CT images and MRI centered on the lumbar spine and recorded in a 70 year-old man with a history of L3 cementoplasty, two months previously. This SPECT/CT recording had been planned for a suspicion of new painful fractures. The SPECT images were initially displayed with a conventional scaling method according to the maximal voxel intensity and further visual adjustment, and a high uptake was observed mainly on the body of L5 (left panel), suggesting the potential benefit of an augmentation procedure targeted on L5. However, the physician in charge of the augmentation procedures found these images to be discordant, as compared with the lesions extending from L2 to L5 on an MRI recorded during the same period (right panel). In a second step, the scale of SPECT images was modified, with a maximum level set at 13 SUV, thus saturating the high uptake level from L5 and providing clear identification of the bone structures reaching a level ≥ 7.5 (median panel). On these new SPECT images, much more diffuse abnormalities were detected, extending from L2 to L5 and with vertebral SUVmax ranging from 10.5 to 31.5, in accordance with the observations provided by MRI.
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