发射型计算机断层显像全身骨扫描联合靶/非靶比值在骨转移瘤中的诊断价值
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摘要
目的探讨发射型计算机断层显像全身骨扫描(WBS)联合病灶的靶/非靶比值(T/NT)在骨转移瘤中的诊断价值。方法收集151例恶性肿瘤患者的临床资料,分析170处骨骼放射性浓聚病灶。比较炎性病变或骨质增生病灶、骨转移病灶、原发性骨肿瘤、术后改变病灶的T/NT,以及肋骨、骨盆和脊柱等不同部位骨转移瘤的T/NT。采用受试者工作特征曲线分析WBS、T/NT及二者联合诊断骨转移瘤的诊断价值。结果原发性骨肿瘤的T/NT最高,炎性病变或骨质增生病灶的T/NT低于骨转移灶和术后改变病灶(均P <0. 05),而术后改变病灶的T/NT与骨转移病灶比较差异无统计学意义(P> 0. 05)。肋骨转移灶的T/NT低于盆骨及脊柱(均P <0. 05),而盆骨与脊柱的转移灶的T/NT比较差异无统计学意义(P> 0. 05)。WBS诊断骨转移瘤的曲线下面积为0. 864,敏感度为84. 9%; T/NT诊断骨转移瘤的曲线下面积为0. 793,敏感性为60. 3%;而WBS联合T/NT诊断骨转移瘤的曲线下面积为0. 917,敏感性达93. 2%。结论骨转移病灶的T/NT高于炎性病变或骨质增生病灶,WBS联合T/NT可以提高骨转移瘤的诊断效能。
Objective To explore the diagnostic value of whole-body bone scintigraphy( WBS) combined with target to non-target ratio( T/NT) of emission computed tomography for bone metastases. Methods The clinical data of 151 patients with malignant tumors were collected,and 170 bone lesions with radioactive concentration were analyzed. The T/NT was compared among inflammatory lesions/hyperosteogeny lesions,bone metastatic lesions,primary bone tumors and lesions with postoperative changes,and among the bone metastases of different locations such as rib,pelvis and spine. The receiver operating characteristic curve was used to analyze the diagnostic value of WBS,T/NT and their combination for bone metastases. Results The T/NT of primary osteosarcoma was the highest,the T/NT of inflammatory lesions/hyperosteogeny lesions was lower than that of bone metastatic lesions and lesions with postoperative changes( all P < 0. 05),but no significant difference between postoperative changes or bone metastases was observed( P > 0. 05). The T/NT of rib metastases was lower than that of pelvis or spine metastases( all P < 0. 05),but there was no significant difference in the T/NT between pelvis and spine metastases( P > 0. 05). For the diagnosis of bone metastases,the areas under the curve of WBS,T/NT and their combination were 0. 864,0. 793 and 0. 917,respectively,and the sensitivities were 84. 9%,60. 3% and 93. 2%,respectively. Conclusion The T/NT of bone metastases is higher than that of inflammatory lesions or hyperosteogeny lesions,and it can improve the diagnostic efficiency for bone metastases when combined with WBS.
Objective To explore the diagnostic value of whole-body bone scintigraphy( WBS) combined with target to non-target ratio( T/NT) of emission computed tomography for bone metastases. Methods The clinical data of 151 patients with malignant tumors were collected,and 170 bone lesions with radioactive concentration were analyzed. The T/NT was compared among inflammatory lesions/hyperosteogeny lesions,bone metastatic lesions,primary bone tumors and lesions with postoperative changes,and among the bone metastases of different locations such as rib,pelvis and spine. The receiver operating characteristic curve was used to analyze the diagnostic value of WBS,T/NT and their combination for bone metastases. Results The T/NT of primary osteosarcoma was the highest,the T/NT of inflammatory lesions/hyperosteogeny lesions was lower than that of bone metastatic lesions and lesions with postoperative changes( all P < 0. 05),but no significant difference between postoperative changes or bone metastases was observed( P > 0. 05). The T/NT of rib metastases was lower than that of pelvis or spine metastases( all P < 0. 05),but there was no significant difference in the T/NT between pelvis and spine metastases( P > 0. 05). For the diagnosis of bone metastases,the areas under the curve of WBS,T/NT and their combination were 0. 864,0. 793 and 0. 917,respectively,and the sensitivities were 84. 9%,60. 3% and 93. 2%,respectively. Conclusion The T/NT of bone metastases is higher than that of inflammatory lesions or hyperosteogeny lesions,and it can improve the diagnostic efficiency for bone metastases when combined with WBS.
引文
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[3]江泽飞,陈佳艺,牛晓辉,等.乳腺癌骨转移和骨相关疾病临床诊疗专家共识(2014版)[J].中华医学杂志,2015,95(4):241-247.
[4]Rao L,Zong Z,Chen Z,et al.18F-Labeled Na F PET-CT in detection of bone metastases in patients with preoperative lung cancer[J].Medicine(Baltimore),2016,95(16):e3 490.
[5]Al-Muqbel KM,Yaghan RJ.Effectiveness of 18F-FDG-PET/CT vs bone scintigraphy in treatment response assessment of bone metastases in breast cancer[J].Medicine(Baltimore),2016,95(21):e3 753.
[6]刘永刚,曹佳实,刘超,等.射频消融治疗转移性脊柱肿瘤的研究进展[J].中国脊柱脊髓杂志,2017(9):838-841.
[7]张凯,韩建奎,李传福,等.骨显像与MRI对骨转移瘤的诊断价值[J].山东大学学报:医学版,2005,43(4):359-360,362.
[8]张永平,兰朋训,周兆霞.MRI和骨显像诊断骨转移瘤的临床价值分析[J].医学影像学杂志,2017,27(10):2 040-2 042.
[9]Hurley C,Mc Carville MB,Shulkin BL,et al.Comparison of18F-FDG-PET-CT and bone scintigraphy for evaluation of osseous metastases in newly diagnosed and recurrent osteosarcoma[J].Pediatr Blood Cancer,2016,63(8):1 381-1 386.