Diagnostic value of quantitative SPECT/CT integrated parameters for differentiating spinal tuberculosis from spinal...

Area of Science:

• Nuclear Medicine
• Radiology
• Oncology

Background:

• Spinal tuberculosis (STB) and spinal metastases (SM) present similar imaging findings.
• Accurate differentiation is crucial for appropriate treatment and patient management.
• Quantitative 99mTc-MDP SPECT/CT offers potential for noninvasive diagnosis.

Purpose of the Study:

• To evaluate the diagnostic accuracy of quantitative 99mTc-MDP SPECT/CT parameters.
• To compare metabolic, CT attenuation, and integrated parameters for differentiating STB from SM.
• To assess the value of integrated parameters in distinguishing these conditions.

Main Methods:

• Retrospective analysis of 212 patients (94 STB, 118 SM) with quantitative 99mTc-MDP SPECT/CT.
• Delineation of volumes of interest (VOIs) on fused SPECT/CT images.
• Acquisition of standardized uptake value (SUV), total bone uptake (TBU), metabolic bone volume (MBV), and CT Hounsfield unit (HU) parameters.
• Analysis of single vertebrae (SM) and paired adjacent vertebrae (STB) for integrated parameters.
• Assessment using ROC analysis, multivariable logistic regression, DeLong's test, and decision curve analysis.

Main Results:

• SM vertebrae showed significantly higher SUVmax, SUVmean, MBV, and tracer bone uptake compared to STB vertebrae (p < 0.001).
• The lesion burden index based on SUVmax (LBI SUVmax) demonstrated high performance (AUC 0.854, sensitivity 95.7%, specificity 73.7%).
• Combined metabolic and CT attenuation models achieved high diagnostic performance (AUC 0.943), outperforming the CT attenuation model and LBI SUVmax.

Conclusions:

• Quantitative 99mTc-MDP SPECT/CT provides objective data for noninvasive differentiation of STB and SM.
• Metabolic integrated parameters derived from SPECT/CT show considerable diagnostic utility.
• This imaging technique can aid clinicians in distinguishing between these two spinal pathologies.