Quantification of (99m)Tc-DPD concentration in the lumbar spine with SPECT/CT

BACKGROUND: Routine single-photon emission computed tomography (SPECT) currently lacks quantitative information on regional activity concentration (ACC) of the injected tracer (e.g. kBq/ml). Furthermore, little is known on the skeletal absolute concentration of (99m)Tc-DPD after intravenous injection in bone scintigraphy. The aim of this study is to determine ACC in the healthy lumbar vertebrae of patients using a recently published quantitative SPECT/computed tomography (CT) protocol. METHODS: Lumbar vertebrae ACC estimates were performed in 50 female patients (mean age 69.88 ± 13.73 years) who had been administered 562.84 ± 102.33 MBq of (99m)Tc-DPD and had undergone SPECT acquisition 4 h after the injection. The SPECT/CT system was calibrated against a well counter. Images were reconstructed with Flash3D. ACC and CT tissue density were measured in volumes of interest drawn over the spongious bone tissue of the three lower lumbar vertebral bodies when these exhibited no focal CT or SPECT pathology. RESULTS: Average ACC measured in the normal spongious bone tissue was 48.15 ± 13.66 kBq/ml (95% confidence interval (CI) 45.81 to 50.50 kBq/ml). This corresponds to a mean standardised uptake value (SUV) of (5.91 ± 1.54) (95% CI (5.64 to 6.17) SUV). SUV correlated significantly with Hounsfield units (HU) (r = 0.678, p < 0.0001). Significant negative correlations were observed between age and HU (r = −0.650, p < 0.0001) and between age and SUV (r = −0.385, p < 0.0001). CONCLUSIONS: The SUVs determined for (99m)Tc-DPD uptake 4 h post injection are in the same range as those reported for [(18)F]fluoride in positron emission tomography. The strong correlation of SUV with bone CT density underlines the physiological significance of this variable. Our data suggest further investigation of the potential value of ACC measurement in the diagnosis of pathological conditions such as osteoporosis or in following up osseous metastases under therapy.