Quantification of bone metabolic activity in the natural course of fractural lesions measured by quantitative SPECT/CT

Document Type : Original Article


1 Department of Molecular Imaging Research, Kobe City Medical Center General Hospital, Japan

2 Department of Nuclear Medicine, Saitama Medical University International Medical Center, Japan

3 Department of Radiology and Nuclear Medicine, Fukushima Medical University, Japan

4 Division of Nuclear Medicine, Department of Radiology, Saitama Medical University Hospital, Japan


Objective(s): While increased uptake at the bone fractural site gradually decreases over time on bone scans, the rate of change has not been quantitatively evaluated. The purpose of this study was to quantify the extent of bone metabolic changes in fractural lesions on bone SPECT/CT.
Methods: We reviewed bone scans acquired by dedicated SPECT/CT and chose those scans in which quantitative SPECT/CT of the same range was acquired twice or more. We set the region of interest on lesions of bone fracture and degeneration, and measured the maximum standardized uptake value (SUVmax). From the SUVmax of lesions and the interval between scans, a value for 30-day change in SUVmax was calculated as DSUVmax30d. The relationship between preSUVmax, SUVmax for the first scan of the comparison, and DSUVmax30d was evaluated utilizing a linear least-squares method. Furthermore, we assessed the ability to differentiate between fracture and degeneration using receiver operating characteristics (ROC) analysis and the Mann-Whitney U test. All cases were then categorized into five groups according to preSUVmax. Values of p <0.05 were considered statistically significant.
Results: We investigated 175 scans from 60 patients and analyzed scan combinations for 157 fractural lesions and 266 degenerative lesions. The relationship between preSUVmax of fractural lesions and DSUVmax30d was approximated as DSUVmax30d =-0.15×preSUVmax +1.35 (R2=0.60, p<0.0001). Area under the curves for all cases, 30≤ preSUVmax, 20≤ preSUVmax <30, 15≤ preSUVmax <20, 10≤ preSUVmax <15, and preSUVmax <10 were 0.73, 0.89, 0.86, 0.80, 0.91, and 0.59, respectively. Median DSUVmax30d was significantly lower at fractural lesions than at degenerative lesions (-0.62 vs -0.04; p <0.0001). As for analyses of groups divided by preSUVmax, all median DSUVmax30d for fractural lesions were significantly lower than those of degenerative lesions except for the group with preSUVmax <10.
Conclusion: The increased uptake at the fractural bone lesion observed in the quantitative bone SPECT/CT gradually decreased at the rate of SUV 0.15 per month, which showed a different trend with degenerative change


Main Subjects

  1. Corcoran RJ, Thrall JH, Kyle RW, Kaminski RJ, Johnson MC. Solitary abnormalities in bone scans of patients with extraosseous Radiology. 1976; 121(3 Pt. 1):663-7.
  2. Matin P. The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med. 1979; 20(12):1227-31.
  3. Lee WW. Clinical Applications of Technetium-99m Quantitative Single-Photon Emission Computed Tomography/ Computed Tomography. Nucl Med Mol Imaging. 2019; 53(3):172-81.
  4. Ross JC, Vilić D, Sanderson T, Vöö S, Dickson J. Does quantification have a role to play in the future of bone SPECT? Eur J Hybrid Imaging. 2019; 3(1):8.
  5. Kangasmaa TS, Constable C, Sohlberg AO. Quantitative bone SPECT/CT reconstruction utilizing anatomical information. EJNMMI Phys. 2021; 8(1):2.
  6. Miyaji N, Miwa K, Tokiwa A, Ichikawa H, Terauchi T, Koizumi M, et al. Phantom and clinical evaluation of bone SPECT/CT image reconstruction with xSPECT algorithm. EJNMMI Res. 2020; 10(1):71.
  7. Kuji I, Yamane T, Seto A, Yasumizu Y, Shirotake S, Oyama M. Skeletal standardized uptake values obtained by quantitative SPECT/CT as an osteoblastic biomarker for the discrimination of active bone metastasis in prostate cancer. Eur J Hybrid Imaging. 2017; 1(1):2.
  8. Hata H, Kitao T, Sato J, Asaka T, Ohga N, Imamachi K, et al. Monitoring indices of bone inflammatory activity of the jaw using SPECT bone scintigraphy: a study of ARONJ patients. Sci Rep. 2020; 10(1):11385.
  9. Kobayashi Y, Okui T, Tsujimoto M, Ikeda H, Satoh K, Kanamori D, et al. Effect of morphological findings in computed tomography on the quantitative values in single-photon emission computed tomography for patients with antiresorptive agent-related osteonecrosis of the jaw: a cross-sectional study. Ann Nucl Med. 2021; 35(7):853-60.
  10. Yamane T, Kuji I, Seto A, Matsunari I. Quantification of osteoblastic activity in epiphyseal growth plates by quantitative bone SPECT/CT. Skeletal Radiol. 2018; 47(6):805-10.
  11. Dittmann H, Kaltenbach S, Weissinger M, Fiz F, Martus P, Pritzkow M, et al. The Prognostic value of quantitative bone SPECT/CT before 223Ra treatment in metastatic castration-resistant postate cancer. J Nucl Med. 2021; 62(1):48-54.
  12. Arvola S, Jambor I, Kuisma A, Kemppainen J, Kajander S, Seppänen M, et al. Comparison of standardized uptake values between 99mTc-HDP SPECT/CT and 18F-NaF PET/CT in bone metastases of breast and prostate cancer. EJNMMI Res. 2019; 9(1):6.
  13. Huang K, Feng Y, Liu D, Liang W, Li L. Quantification evaluation of 99mTc-MDP concentration in the lumbar spine with SPECT/CT: compare with bone mineral density. Ann Nucl Med. 2020; 34(2):136-43.
  14. Kaneta T, Ogawa M, Daisaki H, Nawata S, Yoshida K, Inoue T. SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate. Am J Nucl Med Mol Imaging. 2016; 6(5):262-8.
  15. Katrancioglu O, Akkas Y, Arslan S, Sahin E. Spontaneous rib fractures. Asian Cardiovasc Thorac Ann. 2015; 23(6):701-3.
  16. Yamane T, Fukushima K, Shirotake S, Nishimoto K, Okabe T, Oyama M, et al. Test-retest repeatability of quantitative bone SPECT/CT. Ann Nucl Med. 2021;35(3):338-46.
  17. Cottrell JA, Turner JC, Arinzeh TL, O'Connor JP. The Biology of Bone and Ligament Healing. Foot Ankle Clin. 2016; 21(4):739-61.