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DOI: 10.1055/a-1525-7621
Quantitative Analysis of Multimodal Skeletal SPECT/CT Reconstructions in Diagnosing Medication-related Osteonecrosis of the Jaw
Einsatz der absoluten Quantifizierung von multimodalen SPECT/CT Rekonstruktionen zum Nachweis einer Medikamenten-assoziierten Osteonekrose des Kiefers im Rahmen der SkelettszintigrafieAbstract
Aim Our goal was to assess visual and quantitative aspects of multimodal skeletal SPECT/CT reconstructions (recon) in differentiating necrotic and healthy bone of patients with suspected MRONJ.
Methods Prior to surgery, 20 patients with suspected MRONJ underwent SPECT/CT of the jaw 3–4 hours after injection of Tc-99m-DPD (622±112.4 MBq). SPECT/CT data were reconstructed using the multimodal xSPECT Bone and xSPECT Quant algorithms as well as the OSEM-algorithm FLASH 3D. For analysis, we divided the jaw into 12 separate regions. Both xSPECT Bone and FLASH 3D datasets were scored on a four-point scale (VIS xSPECT; VIS F3D), based on the intensity of localized tracer uptake. In F3D and xSPECT Quant datasets, local tracer uptake of each region was recorded as semi-quantitative uptake ratio (SQR F3D) or SUVs, respectively. ROC analysis was performed. Postoperative histologic results served as gold standard.
Results VIS F3D, VIS xSPECT and SQR F3D did not differ significantly in diagnostic accuracy (VIS xSPECT sensitivity=0.64; specificity=0.89). Of the quantitative parameters, SUVpeak yielded the best interobserver reproducibility. SUVpeak was 9.9±7.1 (95%CI: 7.84–11.95) in MRONJ regions, as opposed 3.6±1.8 (95% CI:3.36–3.88) elsewhere, with a cutpoint of 4.5 (sensitivity=0.83; specificity=0.80). Absolute quantitation significantly surpassed VIS and SQR (p<0.05) in accuracy and interobserver agreement (SUVpeak: κ=0.92; VIS xSPECT: κ=0.61; SQR F3D κ=0.66).
Conclusion Absolute quantitation proved significantly more accurate than visual and semi-quantitative assessment in diagnosing MRONJ, with higher interobserver agreement.
Zusammenfassung
Ziel Ziel unserer Studie war es, dass Potenzial der quantitativen Auswertung von multimodalen SPECT/CT-Rekonstruktionen (Recon) zum Nachweis von Kiefernekrosen bei Patienten mit vermuteter MRONJ zu untersuchen.
Methoden Präoperativ wurden 20 Patienten mit vermuteter MRONJ 3–4h nach Injektion von im Mittel 622±112,4MBq Tc-99m-DPD mittels SPECT/CT untersucht. Die Daten wurden sowohl mittels xSPECT Bone und xSPECT Quant als auch mittels des konventionellen OSEM-Algorithmus Flash3D (F3D) rekonstruiert. Zur Auswertung wurde der Kieferknochen in 12 Regionen unterteilt. Die xSPECT Bone und F3D Recon wurden hinsichtlich der Höhe des Uptakes mithilfe einer visuellen 4-Punkte-Skala (VIS xSPECT; VIS F3D) ausgewertet. Zusätzlich erfolgte eine VOI-basierte Bestimmung von semiquantitativen Ratios anhand der F3D Recon (SQR F3D) bzw. von SUVs anhand der xSPECT Quant Recon in den gleichen Regionen. Eine ROC-Analyse wurde durchgeführt. Das histologische Ergebnis diente als Goldstandard.
Ergebnisse VIS F3D, VIS xSPECT und SQR F3D zeigten keine signifikanten Unterschiede bei der Genauigkeit und Inter-Observer-Reliabilität (VIS F3D Sensitivität=0,62; Spezifität=0,88). Der SUVpeak lag in MRONJ-Regionen bei 9,9±7,1 (95%-KI 7,84–11,95) im Vergleich zu 3,6±1,8 (95%-KI 3,36–3,88) im übrigen Kiefer bei einem Cut-off-Wert von 4,5 (Sensitivität=0,83; Spezifität=0,80). Die Quantifizierung war dem VIS und dem SQR sowohl bei der Genauigkeit (p<0,05) als auch bei der Inter-Observer-Reliabilität (SUVpeak κ=0,92; VIS xSPECT κ=0,61; SQR F3D κ=0,66) überlegen.
Schlussfolgerung Die absolute Quantifizierung zeigt, bei höherer Inter-Observer-Reliabilität, im Vergleich zur visuellen und semiquantitativen Evaluation eine überlegene Genauigkeit beim Nachweis einer MRONJ.
Schlüsselwörter
MRONJ - Quantitative SPECT/CT - Multimodale SPECT-Rekonstruktion - Multimodale SPECT/CTPublication History
Received: 10 December 2020
Accepted after revision: 07 June 2021
Article published online:
11 August 2021
© 2021. Thieme. All rights reserved.
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