~(99)Tc~m-MDP骨显像SUV值在鼻咽癌颅底侵犯诊断价值初步研究
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摘要
目的通过传统~(99)Tc~m-MDP(锝-99亚甲基二膦酸盐)全身骨单光子发射计算机断层成像术/电子计算机断层扫描(single-photon emission computed tomography/computed tomography,SPECT/CT)显像,计算鼻咽癌患者颅底骨质基于放射活度的标准摄取值(standardized uptake value,SUV),观察~(99)Tc~m-MDP全身骨SPECT/CT显像中的颅底区域SUV对鼻咽癌颅底骨质侵犯的增益价值及阳性诊断的最佳SUV界值范围。方法选取2016年6月至2017月1月本院确诊鼻咽癌并行全身骨显像患者51例,男40例,女11例,年龄27～77岁,平均年龄50. 4±10.7岁,其中28例鼻咽部磁共振成像(magnetic resonance imaging,MRI)证实伴颅底骨质侵犯,23例鼻咽部MRI证实未见颅底骨质侵犯。通过定量分析软件分析融合图像,勾勒感兴趣区(region of interest,ROI),测得颅底骨质侵犯组及颅底骨质非侵犯组的最大标准化摄取值(SUVmax)及平均标准化摄取值(SUVmean),并采用t检验和受试者工作特征曲线(receiver operating characteristic curve,ROC)计算两组的界值。结果颅底骨质侵犯组28例SUVmax平均值为3.17(标准差为1.38);颅底骨质非侵犯组23例SUVmax平均值为1.34(标准差为0. 39)。两组比较,t=6. 129,P <0. 001,差异有统计学意义。颅底骨质侵犯组28例SUVmean平均值为0.45(标准差为0. 16);颅底骨质非侵犯组23例SUVmean平均值为0. 9(标准差为0. 37)。两组比较,t=5. 80,P <0.001,差异有统计学意义。51例鼻咽癌患者的SUVmax按颅底骨质侵犯组和颅底骨质非侵犯组进行ROC曲线分析,曲线下面积为0.961,阈值为1.85时,灵敏度为89%,特异性为92%;51例鼻咽癌患者的SUVmean按颅底骨质侵犯组和颅底骨质非侵犯组进行ROC曲线分析,曲线下面积为0.904,阈值为0.55时,灵敏度为82%,特异性为79%。结论全身骨SPECT/CT显像测得基于放射活度的SUV值与鼻咽癌颅底骨质侵犯与否具有良好的相关性,因此SPECT/CT SUV值为鼻咽癌全身骨SPECT/CT显像提供了一种新的具有较高的准确性辅助诊断信息,初步得出在SUVmax为1.85时其对鼻咽癌颅底骨质侵犯诊断价值较高,故SUVmax为1. 85可作为最佳诊断阈值。
Objective With the ~(99)Tc~m-MDP whole body bone images under the conventional SPECT/CT(single-photon emission computed-tomography/computed tomography),to conduct a quantitative analysis on the radioactivity of SPECT/CT images that was applied to the whole body bone scan of patients with nasopharyngeal carcinoma and the best SUV(standardized uptake value) of the skull base sclerotin in the whole body bone images was calculated. The additional value of SUV in the diagnosis of skull base sclerotin invasion of nasopharyngeal carcinoma in the whole body bone scan,and the range of the best critical SUV for positive diagnosis were evaluated. Methods A total of 51 patients who were identified as nasopharyngeal carcinoma in our hospital from June,2016 to January,2017 were selected for the study,including 40 males and 11 females,aged 27-77 years old, with an average age of 50.4±10.7 years old. Among them, 28 patients were confirmed with skull base invasion through nasopharynx MRI( magnetic resonance imaging). Skull base invasion was not observed in the remaining of the patients through nasopharynx MRI. We used student's test(t-test)and receiver operating characteristic curve(ROC) to calculate the cut off to analyze the fused image and drew the region of interest ROI( Region of Interest) with quantitative analysis software(Tiansi Yinghong,Beijing) and obtained the maximum and average SUVs of the skull base invasion group and the control group.Results The average of SUVmax of 28 patients with skull base invasion was 3.17(standard deviation : 1.38);the average of SUVmax of the control group was 1.34(standard deviation:0.39). The t-test value was 6.129(P <0. 001), suggesting a significant difference between the two groups. The SUVmean of 28 affected patients was 0. 45( standard deviation: 0. 16); the SUVmean of the control group was 0. 9( standard deviation:0. 37). The t value was 5. 80( P < 0. 001), suggesting a significant difference between the two groups. The SUVmax of 51 nasopharyngeal carcinoma patients were analyzed by ROC(Receiver Operating Characteristic Curve) according to skull base invasion group and non-invasion skull base group. The area under the curve was 0. 961. At a threshold value of 1. 85, the sensitivity was 89% and the specificity was92%; SUVmean of 51 patients with nasopharyngeal carcinoma was analyzed by ROC curve according to skull base invasion group and non-invasion skull base group. The area under the curve was 0.904. When the threshold was 0.55,the sensitivity was 82% and the specificity was 79%. Conclusion The SUV value of the whole-body bone scans measured on radioactivity had a good correlation with the presence or absence of skull base bone invasion in nasopharyngeal carcinoma. Therefore, the value of SPECT/CT SUV provides a new diagnostic information for the whole-body bone scans of nasopharyngeal carcinoma,We therefore conclude that the SUVmax of 1. 85 has high diagnostic value for skull base bone invasion of nasopharyngeal carcinoma,so SUVmax of 1.85 can be used as the best diagnostic threshold.
Objective With the ~(99)Tc~m-MDP whole body bone images under the conventional SPECT/CT(single-photon emission computed-tomography/computed tomography),to conduct a quantitative analysis on the radioactivity of SPECT/CT images that was applied to the whole body bone scan of patients with nasopharyngeal carcinoma and the best SUV(standardized uptake value) of the skull base sclerotin in the whole body bone images was calculated. The additional value of SUV in the diagnosis of skull base sclerotin invasion of nasopharyngeal carcinoma in the whole body bone scan,and the range of the best critical SUV for positive diagnosis were evaluated. Methods A total of 51 patients who were identified as nasopharyngeal carcinoma in our hospital from June,2016 to January,2017 were selected for the study,including 40 males and 11 females,aged 27-77 years old, with an average age of 50.4±10.7 years old. Among them, 28 patients were confirmed with skull base invasion through nasopharynx MRI( magnetic resonance imaging). Skull base invasion was not observed in the remaining of the patients through nasopharynx MRI. We used student's test(t-test)and receiver operating characteristic curve(ROC) to calculate the cut off to analyze the fused image and drew the region of interest ROI( Region of Interest) with quantitative analysis software(Tiansi Yinghong,Beijing) and obtained the maximum and average SUVs of the skull base invasion group and the control group.Results The average of SUVmax of 28 patients with skull base invasion was 3.17(standard deviation : 1.38);the average of SUVmax of the control group was 1.34(standard deviation:0.39). The t-test value was 6.129(P <0. 001), suggesting a significant difference between the two groups. The SUVmean of 28 affected patients was 0. 45( standard deviation: 0. 16); the SUVmean of the control group was 0. 9( standard deviation:0. 37). The t value was 5. 80( P < 0. 001), suggesting a significant difference between the two groups. The SUVmax of 51 nasopharyngeal carcinoma patients were analyzed by ROC(Receiver Operating Characteristic Curve) according to skull base invasion group and non-invasion skull base group. The area under the curve was 0. 961. At a threshold value of 1. 85, the sensitivity was 89% and the specificity was92%; SUVmean of 51 patients with nasopharyngeal carcinoma was analyzed by ROC curve according to skull base invasion group and non-invasion skull base group. The area under the curve was 0.904. When the threshold was 0.55,the sensitivity was 82% and the specificity was 79%. Conclusion The SUV value of the whole-body bone scans measured on radioactivity had a good correlation with the presence or absence of skull base bone invasion in nasopharyngeal carcinoma. Therefore, the value of SPECT/CT SUV provides a new diagnostic information for the whole-body bone scans of nasopharyngeal carcinoma,We therefore conclude that the SUVmax of 1. 85 has high diagnostic value for skull base bone invasion of nasopharyngeal carcinoma,so SUVmax of 1.85 can be used as the best diagnostic threshold.
引文
[1]康国庆,侯磊,吴晓辉,等.鼻咽癌颅底骨侵犯SPECT与CT检测对比研究[J].包头医学院学报,2016,32(5):104-105.
[2]赵波洋,陈树平,吕涵青,等.SPECT-CT与MRI在鼻咽癌早期颅底侵犯方面的比较研究[J].中国医学创新,2017,14(15):124-127.
[3]马秀梅,陈涛,李莉,等.MRI、增强CT和PET-CT对鼻咽癌颅底侵犯诊断价值的对比分析[J].肿瘤,2008,28(9):795-798.
[4]ZEINTL J, VIJA A H, YAHIL A, et al. Quantitative accuracy of clinical 99mTc SPECT/CT using ordered-subset expectation maximzation with 3-dimensional resolution recovery, attenuation,and scatter correction[J]. J Nucl Med,2010,51(51):921-928.
[5]ZIMMERMAN B E, GROSEV D, BUVAT I, et al. Multi-centre evaluation of accuracy and reproducibility of planar and SPECT image quantification:An IAEA phantom study[J]. Z Med Phys,2017,27(2):98-112.
[6]WILLOWSON K,BAILEY D L,BALDOCK C. Quantitative SPECT reconstruction using CT-derived corrections[J]. Phys Med Biol,2008,53(12):3099-3112.
[7]SUH M S, LEE W W, KIM Y K, et al. Maximum standardized uptake value of(99m)Tc hydroxymethylene diphosphonate SPECT/CT for the evaluation of temporomandibular joint disorder[J].Radiology,2016,280(3):890-896.
[8]熊伟,李兴,史德刚,等.~(99)Tc~m-MDP SPECT/CT对于股骨头缺血性坏死骨代谢的定量分析研究[J].实用骨科杂志,2015,21(9):806-811.
[9]KANETA T,OGAWA M, DAISAKI H, et al. SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate[J]. Am J Nucl Med Mol Imaging, 2016,6(5):262-268.
[10]KIM J,LEE HH,KANG Y, et al. Maximum standardised uptakevalue of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee[J]. Clin Radiol, 2017, 72(7):580-589.
[11]董科,石洪成,刘江,等.SPECT/CT显像在肿瘤骨转移同一病灶动态随访中的价值[J].中华核医学与分子影像杂志,2013,33(3):199-202.
[12]艾毅钦,刘光贤,李荣清,等.SPECT和CT检测鼻咽癌颅底受侵的临床价值[J].中华肿瘤防治杂志,2010,17(2):119-121.
[13]张莉,王晋川,蒲诺,等.鼻咽癌颅底骨侵犯SPECT及CT检测对比研究[J].中华放射肿瘤学杂志,2002,11(1):8-11.
[14]张莉,敖睿,王晋川,等.鼻咽癌颅底骨侵犯SPECT及MR检测对比研究[J].中华放射肿瘤学杂志,2008,17(6):417-420.
[15]姚红霞,刘生,蒋宁一,等.~(99)Tc~m-MDP SPECT结合定位CT评价鼻咽癌颅底骨侵犯[J].中华核医学杂志,2009,29(5):303-305.
[2]赵波洋,陈树平,吕涵青,等.SPECT-CT与MRI在鼻咽癌早期颅底侵犯方面的比较研究[J].中国医学创新,2017,14(15):124-127.
[3]马秀梅,陈涛,李莉,等.MRI、增强CT和PET-CT对鼻咽癌颅底侵犯诊断价值的对比分析[J].肿瘤,2008,28(9):795-798.
[4]ZEINTL J, VIJA A H, YAHIL A, et al. Quantitative accuracy of clinical 99mTc SPECT/CT using ordered-subset expectation maximzation with 3-dimensional resolution recovery, attenuation,and scatter correction[J]. J Nucl Med,2010,51(51):921-928.
[5]ZIMMERMAN B E, GROSEV D, BUVAT I, et al. Multi-centre evaluation of accuracy and reproducibility of planar and SPECT image quantification:An IAEA phantom study[J]. Z Med Phys,2017,27(2):98-112.
[6]WILLOWSON K,BAILEY D L,BALDOCK C. Quantitative SPECT reconstruction using CT-derived corrections[J]. Phys Med Biol,2008,53(12):3099-3112.
[7]SUH M S, LEE W W, KIM Y K, et al. Maximum standardized uptake value of(99m)Tc hydroxymethylene diphosphonate SPECT/CT for the evaluation of temporomandibular joint disorder[J].Radiology,2016,280(3):890-896.
[8]熊伟,李兴,史德刚,等.~(99)Tc~m-MDP SPECT/CT对于股骨头缺血性坏死骨代谢的定量分析研究[J].实用骨科杂志,2015,21(9):806-811.
[9]KANETA T,OGAWA M, DAISAKI H, et al. SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate[J]. Am J Nucl Med Mol Imaging, 2016,6(5):262-268.
[10]KIM J,LEE HH,KANG Y, et al. Maximum standardised uptakevalue of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee[J]. Clin Radiol, 2017, 72(7):580-589.
[11]董科,石洪成,刘江,等.SPECT/CT显像在肿瘤骨转移同一病灶动态随访中的价值[J].中华核医学与分子影像杂志,2013,33(3):199-202.
[12]艾毅钦,刘光贤,李荣清,等.SPECT和CT检测鼻咽癌颅底受侵的临床价值[J].中华肿瘤防治杂志,2010,17(2):119-121.
[13]张莉,王晋川,蒲诺,等.鼻咽癌颅底骨侵犯SPECT及CT检测对比研究[J].中华放射肿瘤学杂志,2002,11(1):8-11.
[14]张莉,敖睿,王晋川,等.鼻咽癌颅底骨侵犯SPECT及MR检测对比研究[J].中华放射肿瘤学杂志,2008,17(6):417-420.
[15]姚红霞,刘生,蒋宁一,等.~(99)Tc~m-MDP SPECT结合定位CT评价鼻咽癌颅底骨侵犯[J].中华核医学杂志,2009,29(5):303-305.