~(99)Tc~m-MDP SPECT/CT诊断宫颈癌放疗后骨盆不全骨折
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摘要
目的探讨~(99 )Tc~m-MDP SPECT/CT诊断宫颈癌放疗后骨盆不全骨折(PIF)的价值。方法回顾性分析37例宫颈癌放疗后疑似PIF患者的全身显像(WBS)和骨盆SPECT/CT断层融合显像资料。以影像学资料、临床资料及随访(>12个月)结果作为最终诊断PIF的标准,比较WBS、SPECT/CT对PIF的诊断效能。结果37例患者共50个骨盆病灶,最终诊断PIF 42个(30例)。WBS诊断PIF的灵敏度为45.24%(19/42),特异度50.00%(4/8),准确率46.00%(23/50);SPECT/CT诊断PIF的灵敏度为92.86%(39/42),特异度75.00%(6/8),准确率90.00%(45/50);SPECT/CT诊断宫颈癌放疗后PIF的灵敏度及准确率均高于WBS(χ~2=22.28、22.24,P均<0.01),但二者特异度差异无统计学意义(P=0.31)。结论~(99 )Tc~m-MDP SPECT/CT可用于诊断宫颈癌放疗后PIF。
Objective To explore the value of ~(99 )Tc~m-MDP SPECT/CT in diagnosis of pelvic insufficiency fracture(PIF)of cervical cancer after radiotherapy.Methods Whole body scan(WBS)and ~(99 )Tc~m-MDP SPECT/CT data of 37suspected PIF patients with cervical cancer after radiotherapy were retrospectively analyzed.The diagnosis standard of PIF was based on radiologic investigation,clinical information and follow up for at least 12months.The efficiency in diagnosis of PIF was compared between WBS and SPECT/CT.Results Among 37patients(50pelvic lesions),42PIF lesions were diagnosed in 30patients.The diagnostic sensitivity,specificity and accuracy of WBS diagnosis of PIF were 45.24%(19/42),50.00%(4/8)and 46.00%(23/50),while of SPECT/CT diagnosis of PIF were 92.86%(39/42),75.00%(6/8)and90.00%(45/50),respectively.The diagnostic sensitivity and accuracy of SPECT/CT were significantly higher than those of WBS(χ~2=22.28,22.24,both P<0.01),and no significant difference of specificity was found between WBS and SPECT/CT(P=0.31).Conclusion ~(99 )Tc~m-MDP SPECT/CT can be used for diagnosis of PIF.
Objective To explore the value of ~(99 )Tc~m-MDP SPECT/CT in diagnosis of pelvic insufficiency fracture(PIF)of cervical cancer after radiotherapy.Methods Whole body scan(WBS)and ~(99 )Tc~m-MDP SPECT/CT data of 37suspected PIF patients with cervical cancer after radiotherapy were retrospectively analyzed.The diagnosis standard of PIF was based on radiologic investigation,clinical information and follow up for at least 12months.The efficiency in diagnosis of PIF was compared between WBS and SPECT/CT.Results Among 37patients(50pelvic lesions),42PIF lesions were diagnosed in 30patients.The diagnostic sensitivity,specificity and accuracy of WBS diagnosis of PIF were 45.24%(19/42),50.00%(4/8)and 46.00%(23/50),while of SPECT/CT diagnosis of PIF were 92.86%(39/42),75.00%(6/8)and90.00%(45/50),respectively.The diagnostic sensitivity and accuracy of SPECT/CT were significantly higher than those of WBS(χ~2=22.28,22.24,both P<0.01),and no significant difference of specificity was found between WBS and SPECT/CT(P=0.31).Conclusion ~(99 )Tc~m-MDP SPECT/CT can be used for diagnosis of PIF.
引文
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[11] Lyders EM, Whitlow CT,Baker MD,et al.Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol,2010,31(2):201-210.
[12] Cabarrus MC,Ambekar A,Lu Y,et al.MRI and CT of insufficiency fractures of the pelvis and the proximal femur.AJR Am J Roentgenol,2008,191(4):995-1001.
[13] Zhang L,He Q,Li W,et al.The value of 99mTc-methylene diphosphonate single photon emission computed tomography/computed tomography in diagnosis of fibrous dysplasia.BMC Med Imaging,2017,17(1):46.
[14]张斌青,刘云,郭会利,等.99 Tcm-MDP SPECT/CT诊断钳夹型髋关节撞击综合征.中国医学影像技术,2017,33(1):106-109.
[15]张林启,覃艺芳,李伟,等.常规SPECT/CT断层融合显像诊断高危前列腺癌患者骨转移.中国医学影像技术,2017,33(2):260-264.
[16] Makino H,Nishio S,Tsubamoto H,et al.Treatment and prognosis of bone metastasis from cervical cancer(KCOGG1202s).Obstet Gynaecol Res,2016,42(6):701-706.
[2] Bazire L,Xu H,Foy JP,et al.Pelvic insufficiency fracture(PIF)incidence in patientstreated with intensity-modulated radiation therapy(IMRT)for gynaecological or anal cancer single-institution experience and review of the literature.Br J Radiol,2017,90(1073):20160885.
[3]杨洪娟,书阿克,努尔江,等.宫颈癌调强放疗后骨盆衰竭骨折的发生率及影响因素分析.中华放射医学与防护杂志,2017,37(3):193-198.
[4] Mueller D,Schaeffeler C,Baum T,et al.Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema,avascular necrosis and subchondral insufficiency fractures of the proximal femur.Eur J Radiol,2014,83(10):1862-1869.
[5] Lapina O,Ti2keviˇcius S.Sacral insufficiency fracture after pelvic radiotherapy:A diagnostic challenge for a radiologist.Medicina(Kaunas),2014,50(4):249-254.
[6] Al-faham Z,Rydberg JN,Oliver Wong CY.Use of SPECT/CT with 99mTc-MDP bone scintigraphy to diagnose sacral insufficiency fracture.J Nucl Med Technol,2014,42(3):240-241.
[7]冯仕庭,孟悛非.机能不全性骨折的影像学进展.国外医学放射学杂志,2004,27(4):238-241.
[8] Uezono H,Tsujino K, Moriki K,et al.Pelvic insufficiency fracture after definitive radiotherapy for uterine cervical cancer:Retrospective analysis of risk factors.J Radiat Res,2013,54(6):1102-1109.
[9] Ikushima H, Osaki K, Furutani S, et al. Pelvic bone complicationsfollowingradiationtherapyofgynecologic malignancies:Clinical evaluation of radiation-induced pelvic insufficiency fractures.Gynecol Oncol,2006,103(3):1100-1104.
[10] Fujii M,Abe K,Hayashi K,et al.Honda sign and variants in patients suspected of having a sacral insufficiency fracture.Clin Nucl Med,2005,30(3):165-169.
[11] Lyders EM, Whitlow CT,Baker MD,et al.Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol,2010,31(2):201-210.
[12] Cabarrus MC,Ambekar A,Lu Y,et al.MRI and CT of insufficiency fractures of the pelvis and the proximal femur.AJR Am J Roentgenol,2008,191(4):995-1001.
[13] Zhang L,He Q,Li W,et al.The value of 99mTc-methylene diphosphonate single photon emission computed tomography/computed tomography in diagnosis of fibrous dysplasia.BMC Med Imaging,2017,17(1):46.
[14]张斌青,刘云,郭会利,等.99 Tcm-MDP SPECT/CT诊断钳夹型髋关节撞击综合征.中国医学影像技术,2017,33(1):106-109.
[15]张林启,覃艺芳,李伟,等.常规SPECT/CT断层融合显像诊断高危前列腺癌患者骨转移.中国医学影像技术,2017,33(2):260-264.
[16] Makino H,Nishio S,Tsubamoto H,et al.Treatment and prognosis of bone metastasis from cervical cancer(KCOGG1202s).Obstet Gynaecol Res,2016,42(6):701-706.