SPECT/CT融合显像在~（99m）Tc-MDP脊柱浓聚灶中良恶性诊断价值的研究
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摘要
目的:评价SPECT/CT骨显像在脊柱浓聚灶中良恶性的诊断价值。方法:选取100例99mTc-MDP骨显像可疑脊柱浓聚灶病人,男56例,女44例,年龄22—83岁,平均(61.53±14.76)岁,其中73例病理确诊原发灶为恶性肿瘤,主要为肺癌、乳腺癌、前列腺癌,结核14例,不明原因骨痛为13例,进行SPECT/CT同机融合,与病理(含术中病理)对照25例,随访1年对照19例,CT与MRI共同对照56例。结果:SPECT/CT显像对可疑脊柱浓聚灶诊断骨转移性肿瘤的敏感度为83.87%,特异度88.41%,准确度87.00%,阳性预测值76.47%,阴性预测值92.42%,阳性似然比7.23,阴性似然比0.18。结论:全身骨显像由于其价格便宜、灵敏度高,在骨转移性肿瘤的诊断中得到广泛的应用。但对可疑脊柱浓聚灶性质的判定特异性差,尤其是椎体退行性变、各种原因导致的椎体压缩性骨折所致的放射性浓聚与椎体转移性肿瘤的性质难以区别。SPECT/CT同机图像融合由于诊断级螺旋CT的应用,细节应用了CT在诊断脊柱浓聚灶中的极有价值的信息清晰、细致地显示了脊柱椎体的解剖结构,如能显示椎体、椎弓根、椎小关节等及骨质密度的改变,如溶骨型、成骨型、混合型。再加上亲肿瘤药物99mTc-MDP的合理应用,从而降低了全身骨显像的假阳性率,提高了SPECT/CT在脊柱浓聚灶尤其是单发灶中良恶性鉴别诊断的准确度和特异度。虽然存在一定的假阳性率(23.5%)及假阴性率(7.58%)但是仍不失为一种行之有效的检查方法。
Objective: To evaluate the diagnostic value of SPECT/CT 99mTc-MDP imaging in osseous lesions of spine . Methods:We choose 100 patients with osseous lesions on dorsal spine accepting SPECT/CT 99mTc-MDP imaging. 25 patients and 19 patients and 56 patients with lesions on dorsal spine were confirmed by histopathology examination, clinical 1 year follow-up and CT and MRI results, respectively. Results:Sensitivity of diagnosis of the metastatic bone tumor with SPECT/CT 99mTc-MDP imaging in osseous lesions of dorsal spine is 83.87% , specificity is 88.41%, coincidence is 87.00%, positive predictive value is 76.47%, negative predictive value is 92.42%.positive likelihood ratio is 7.23, negative likelihood ratio is 0.18. Conclusions:Because the bone scan is cheap and the Sensitivity of diagnosis of the metastatic bone tumor is high .but, bone scan has some disadvantage .Applied the diagnostic CT of SPECT/CT can give many detail information to diagnosis osseous lesions of spine. While the result of bone scan and CT were discordant, the fusion information of SPECT/CT can give the accurate diagnosis and differentiate malignancy from benignancy in osseous lesions of spine .
Objective: To evaluate the diagnostic value of SPECT/CT 99mTc-MDP imaging in osseous lesions of spine . Methods:We choose 100 patients with osseous lesions on dorsal spine accepting SPECT/CT 99mTc-MDP imaging. 25 patients and 19 patients and 56 patients with lesions on dorsal spine were confirmed by histopathology examination, clinical 1 year follow-up and CT and MRI results, respectively. Results:Sensitivity of diagnosis of the metastatic bone tumor with SPECT/CT 99mTc-MDP imaging in osseous lesions of dorsal spine is 83.87% , specificity is 88.41%, coincidence is 87.00%, positive predictive value is 76.47%, negative predictive value is 92.42%.positive likelihood ratio is 7.23, negative likelihood ratio is 0.18. Conclusions:Because the bone scan is cheap and the Sensitivity of diagnosis of the metastatic bone tumor is high .but, bone scan has some disadvantage .Applied the diagnostic CT of SPECT/CT can give many detail information to diagnosis osseous lesions of spine. While the result of bone scan and CT were discordant, the fusion information of SPECT/CT can give the accurate diagnosis and differentiate malignancy from benignancy in osseous lesions of spine .
引文
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[12] Nakamoto Y, Chin BB , Cohade C , et al .PET/CT: artifacts caused by bowel motion[J]. Nucl Med Commun , 2004 , 25(3) :221-225.
[13]陈跃,黄占文,等. SPECT-CT的临床应用进展[J].国际放射医学核医学杂志,2006, 30(5): 280-282.
[14] Schillaci O , Danieli R , Manni C , et al .Is SPECT/ CT with a hybrid camera useful to improve scintigraphic imaging interpretation [J ] Nucl Med Commun , 2004 , 25 ( 7) :705 - 710.
[15]查金顺. SPECT-CT—核医学影像技术的新阶段[J].国际放射医学核医学杂志, 2007 , 31(3): 135-138.
[16] Delbeke D , Coleman RE , Guiberteau MJ ,et al . Procedure Guideline for SPECT/ CT Imaging 1. 0 [J ] . J Nucl Med , 2006 , 47 (7) : 1227 - 1234.
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