{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:09:36Z","timestamp":1792757376497,"version":"4.5.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To evaluate the diagnostic value of quantitative\n                      <jats:sup>99m<\/jats:sup>\n                      Tc-MDP SPECT\/CT metabolic, CT attenuation, and adjacent vertebra integrated parameters for differentiating spinal tuberculosis (STB) from spinal metastases (SM).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included 212 patients who underwent quantitative\n                      <jats:sup>99m<\/jats:sup>\n                      Tc-MDP SPECT\/CT, including 94 with STB and 118 with SM. Volumes of interest (VOIs) were delineated on fused SPECT\/CT images, from which standardized uptake value (SUV), total bone uptake (TBU), metabolic bone volume (MBV), and CT Hounsfield unit (HU) parameters were obtained. One target metastatic vertebra was analyzed in each SM patient, whereas paired adjacent involved vertebrae were used to construct integrated parameters in STB patients. Diagnostic performance was assessed using ROC analysis, multivariable logistic regression, DeLong\u2019s test, and decision curve analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SUVmax, SUVmean, metabolic bone volume, tracer bone uptake, CT HUmax, and CT HUmean were significantly higher in SM target vertebrae than in STB involved vertebrae, all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001. Among single integrated parameters, the lesion burden index based on SUVmax (LBI\n                      <jats:sub>SUVmax<\/jats:sub>\n                      ) showed the best performance, with an AUC of 0.854, sensitivity of 95.7%, and specificity of 73.7%. The AUCs of the metabolic, CT attenuation, and combined models were 0.938, 0.810, and 0.943, respectively. DeLong\u2019s test showed that the combined model outperformed the CT attenuation model, LBI\n                      <jats:sub>SUVmax<\/jats:sub>\n                      , but not the metabolic model,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.422.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Quantitative\n                      <jats:sup>99m<\/jats:sup>\n                      Tc-MDP SPECT\/CT provides objective information for noninvasive differentiation of STB and SM, and metabolic integrated parameters may offer useful diagnostic value.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1890572","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:21:27Z","timestamp":1785385287000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic value of quantitative SPECT\/CT integrated parameters for differentiating spinal tuberculosis from spinal metastases"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiaxing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]},{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Third People\u2019s Hospital of Yinchuan City","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]},{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingqin","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]},{"name":"Department of Nuclear Medicine, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Zhao","sequence":"additional","affiliation":[{"name":"Key Laboratory of Clinical Pathogenic Microorganisms, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]},{"name":"The First Clinical Medical College of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningkui","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]},{"name":"Research Center for Prevention and Control of Bone and Joint Tuberculosis, General Hospital of Ningxia Medical University","place":["Yinchuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101718","article-title":"Evaluation of systems of grading of neurological deficit in tuberculosis of spine","volume":"43","author":"Jain","year":"2005","journal-title":"Spinal Cord"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2021.04.012","article-title":"Spinal metastases 2021: a review of the current state of the art and future directions","volume":"21","author":"Sciubba","year":"2021","journal-title":"Spine J Off J North Am Spine Soc"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.100B4.BJJ-2017-1040.R1","article-title":"Spinal tuberculosis: review of current management","author":"Dunn","year":"2018","journal-title":"Bone Joint J"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.19.00001","article-title":"Tuberculosis of the spine","volume":"102","author":"Jain","year":"2020","journal-title":"J Bone Joint Surg Am Volume"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13172737","article-title":"Diagnostic approach and differences between spinal infections and tumors","volume":"13","author":"Compagnone","year":"2023","journal-title":"Diagnostics (Basel Switzerland)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12050893","article-title":"Imaging of spondylodiscitis: a comprehensive updated review-multimodality imaging findings, differential diagnosis, and specific microorganisms detection","volume":"12","author":"Cromb\u00e9","year":"2024","journal-title":"Microorganisms"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1148\/rg.250055","article-title":"Practical interpretation of bone scintigraphy: metastases, fractures, and beyond","volume":"46","author":"Haug","year":"2026","journal-title":"Radiographics A Rev Publ Radiological Soc North America Inc"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-021-07956-0","article-title":"Prospective comparison of the diagnostic accuracy of 18f-fdg pet\/mri, mri, ct, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients","volume":"31","author":"Bruckmann","year":"2021","journal-title":"Eur Radiol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13182971","article-title":"Quantitative vs. qualitative spect-ct diagnostic accuracy in bone lesion evaluation-a review of the literature","volume":"13","author":"Mutuleanu","year":"2023","journal-title":"Diagnostics (Basel Switzerland)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"89","DOI":"10.4274\/mirt.galenos.2019.20053","article-title":"Diagnostic value of bone spect\/ct in patients with suspected osteomyelitis","volume":"28","author":"Ar\u0131can","year":"2019","journal-title":"Mol Imaging Radionucl Ther"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2019.04.024","article-title":"Role of nuclear medicine imaging in evaluation of orthopedic infections, current concepts","volume":"10","author":"Seltzer","year":"2019","journal-title":"J Clin Orthop Trauma"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1205379","article-title":"The diagnostic value of quantitative bone spect\/ct in solitary undetermined bone lesions","volume":"13","author":"Du","year":"2023","journal-title":"Front Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.792581","article-title":"Single-photon emission computed tomography\/computed tomography image-based radiomics for discriminating vertebral bone metastases from benign bone lesions in patients with tumors","volume":"8","author":"Jin","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"B14","first-page":"198","article-title":"Analysis of the application value of suv in quantitative spect\/ct for diagnosing benign and Malignant bone lesions","volume":"27","author":"Guo","year":"2024","journal-title":"Hellenic J Nucl Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1053\/j.semnuclmed.2023.10.007","article-title":"Pet\/ct and spect\/ct for infection in joints and bones: an overview and future directions","volume":"54","author":"Mokoala","year":"2024","journal-title":"Semin Nucl Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.21147\/j.issn.1000-9604.2018.04.05","article-title":"Differential study of dce-mri parameters in spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis","volume":"30","author":"Qiao","year":"2018","journal-title":"Chin J Cancer Res"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1623598","article-title":"Percutaneous ct-guided or endoscopic spinal biopsy with accurate pathogen detection for spinal infection","volume":"16","author":"Chen","year":"2025","journal-title":"Front Neurol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"4292","DOI":"10.3390\/jcm12134292","article-title":"Factors predicting the final diagnosis in image-guided percutaneous needle biopsy for suspected spinal tumors","volume":"12","author":"Oka","year":"2023","journal-title":"J Clin Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13550-019-0501-1","article-title":"Bone spect-based segmented attenuation correction for quantitative analysis of bone metastasis (b-sac): comparison with ct-based attenuation correction","volume":"9","author":"Nakahara","year":"2019","journal-title":"EJNMMI Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1186\/s12885-022-09702-1","article-title":"Is it sufficient to evaluate metastatic bone involvement in breast cancer using spect\/ct? A new approach of spect\/ct-guided targeted bone marrow biopsy","volume":"22","author":"Li","year":"2022","journal-title":"BMC Cancer"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3159","DOI":"10.3390\/molecules26113159","article-title":"Radiotracers for bone marrow infection imaging","volume":"26","author":"Jodal","year":"2021","journal-title":"Molecules"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100040206","article-title":"Localization of technetium-99m methylene diphosphonate in bone using microautoradiography","volume":"4","author":"Einhorn","year":"1986","journal-title":"J Orthop Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2714","DOI":"10.3390\/diagnostics14232714","article-title":"Diagnostic ability of quantitative parameters of whole-body bone spect\/ct using a full-ring 360 degrees cadmium-zinc-telluride camera for detecting bone metastasis in patients with prostate cancer","volume":"14","author":"Yoo","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2907","DOI":"10.3390\/diagnostics15222907","article-title":"Quantitative bone spect\/ct in diabetic foot osteomyelitis: diagnostic performance within-patient lesion-contralateral separation and associations with inflammatory burden","volume":"15","author":"Yalcin","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.3390\/diagnostics15162109","article-title":"Predictive value of (99m)tc dpd bone spect\/ct uptake ratio for culture results in lower limb osteomyelitis","volume":"15","author":"Shin","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1119214","article-title":"Skeletal standardized uptake values obtained using quantitative spect\/ct for the detection of bone metastases in patients with lung adenocarcinoma","volume":"10","author":"Lin","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"3785","DOI":"10.3390\/ijms24043785","article-title":"The role of cytokines in the metastasis of solid tumors to the spine: systematic review","volume":"24","author":"\u0141ab\u0119d\u017a","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-023-05162-7","article-title":"Radiomics-clinical model based on (99m)tc-mdp spect\/ct for distinguishing between bone metastasis and benign bone disease in tumor patients","volume":"149","author":"Wang","year":"2023","journal-title":"J Cancer Res Clin Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2019.05.002","article-title":"Spinal tuberculosis: a comprehensive review for the modern spine surgeon","volume":"19","author":"Khanna","year":"2019","journal-title":"Spine J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"21925682231173646","DOI":"10.1177\/21925682231173646","article-title":"Management of metastatic spinal disease \u2013 a practical approach","author":"Shea","year":"2024","journal-title":"Global Spine J"},{"key":"B31","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13244-022-01172-0","article-title":"Extrapulmonary tuberculos\u0131s: an old but resurgent problem","volume":"13","author":"Baykan","year":"2022","journal-title":"Insights Imaging"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1320574","article-title":"Nuclear medicine imaging for bone metastases assessment: what else besides bone scintigraphy in the era of personalized medicine","volume":"10","author":"Ouvrard","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"B33","article-title":"Specific tuberculosis immunity during infection","volume":"16","author":"Corper","year":"1944","journal-title":"Yale J Biol Med"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20110919","article-title":"Regulation of neutrophils by interferon-gamma limits lung inflammation during tuberculosis infection","volume":"208","author":"Nandi","year":"2011","journal-title":"J Exp Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1186\/s40001-024-02198-4","article-title":"Surgical treatment of spinal tuberculosis: an updated review","volume":"29","author":"Gan","year":"2024","journal-title":"Eur J Med Res"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1230572","article-title":"A high proportion of caseous necrosis, abscess, and granulation tissue formation in spinal tuberculosis","volume":"14","author":"Wu","year":"2023","journal-title":"Front Microbiol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S298316","article-title":"Development and validation of a scoring system for differential diagnosis of tuberculosis and metastatic tumor in the spine","volume":"14","author":"Cao","year":"2021","journal-title":"Infect Drug Resist"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1012440","article-title":"Intravoxel incoherent motion to differentiate spinal metastasis: a pilot study","volume":"12","author":"Zhang","year":"2022","journal-title":"Front Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1890572\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:21:28Z","timestamp":1785385288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1890572\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":38,"alternative-id":["10.3389\/fonc.2026.1890572"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1890572","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"article-number":"1890572"}}