Abstract
BackgroundRecently, a standardized uptake value (SUV) has been used to evaluate bone single-photon emission computed tomography (SPECT). The aim of this study was to investigate quantitative SPECT imaging of uninfected nonunion to compare hypertrophic nonunion and non-hypertrophic nonunion using volume-based parameters.MethodsWe evaluated 23 patients with uninfected nonunion who underwent SPECT acquisition 3 h after an injection of 99mTc-hydroxymethylene diphosphonate or 99mTc-methylene diphosphonate from April 2014 to November 2019. We reconstructed the acquired data and performed voxel-based quantitative analysis using the GI-BONE software. Quantitative parameters, maximum SUV (SUVmax), peak SUV (SUVpeak), and mean SUV (SUVmean) in the high and low uptake areas of nonunion were compared between hypertrophic nonunion and non-hypertrophic nonunion. The contralateral limb was used as a control, and the ratios of the quantitative parameters were calculated.ResultsThe values for the quantitative parameters (high uptake area/low uptake area, respectively), SUVmax control ratio (12.13 ± 4.95/6.44 ± 4.71), SUVpeak control ratio (11.65 ± 4.58/6.45 ± 4.64), and SUVmean control ratio (11.94 ± 5.03/6.28 ± 4.95) for hypertrophic nonunion were higher than those for non-hypertrophic nonunion (7.82 ± 4.76/3.41 ± 2.09 (p = 0.065/0.12), 7.56 ± 4.51/3.61 ± 2.23 (p = 0.065/0.22), and 7.59 ± 5.18/3.05 ± 1.91 (p = 0.076/0.23)).ConclusionsSUVmax, SUVpeak, and SUVmean control ratios obtained from bone SPECT images can quantitatively evaluate the biological activity of nonunions and may be an effective evaluation method for treatment decisions, especially the necessity of autologous bone grafting.
Highlights
A standardized uptake value (SUV) has been used to evaluate bone single-photon emission computed tomography (SPECT)
The cause of nonunion is determined by X-ray findings, with the presence of marked callus formation around the nonunion site considered to indicate biological activity
In cases of nonunion without callus formation, it is very difficult to determine the existence of biological activity using only X-ray findings
Summary
A standardized uptake value (SUV) has been used to evaluate bone single-photon emission computed tomography (SPECT). The cause of nonunion is determined by X-ray findings, with the presence of marked callus formation around the nonunion site considered to indicate biological activity. In cases of nonunion without callus formation, it is very difficult to determine the existence of biological activity using only X-ray findings. Biological activity exists around the nonunion without callus in X-ray findings. Bone scintigraphy is considered an important examination for determining biological activity [8,9,10,11,12]. Bone scintigraphy is excellent for qualifying biological activity, it is difficult to quantitatively evaluate biological activity using scintigraphy
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