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Background  Recently, 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.    Methods  We evaluated 23 patients with uninfected nonunion who underwent SPECT acquisition 3 h after an injection of  99m Tc-hydroxymethylene diphosphonate or  99m Tc-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 (SUV max ), peak SUV (SUV peak ), and mean SUV (SUV mean ) 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.    Results  The values for the quantitative parameters (high uptake area/low uptake area, respectively), SUV max  control ratio (12.13 ± 4.95/6.44 ± 4.71), SUV peak  control ratio (11.65 ± 4.58/6.45 ± 4.64), and SUV mean  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)).    Conclusions  SUV max , SUV peak , and SUV mean  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.

journal of orthopaedic surgery and research

Quantitative bone single-photon emission computed tomography imaging for uninfected nonunion: comparison of hypertrophic nonunion and non-hypertrophic nonunion