前列腺癌骨转移的临床诊断:MRI与同位素骨扫描的比较  

Clinical Diagnosis of Bone Metastasis from Prostate Cancer:Comparison of MRI and Bone Scintigraphy

作　　者：何静[1] 王霄英[1] 黄嵘[2] 李飞宇[1] 许玉峰[1] 蒋学祥[1] 

机构地区：[1]北京大学第一医院医学影像科,北京100034 [2]北京大学深圳医院放射科

出　　处：《实用放射学杂志》2007年第4期500-504,共5页Journal of Practical Radiology

摘　　要：目的比较盆腔MRI和全身骨扫描对前列腺癌骨转移的临床诊断效能。方法收集183例前列腺疾病患者的资料,包括盆腔MRI和全身骨扫描检查结果。根据临床综合诊断结果,将所有患者分为骨转移组和非骨转移组。对获得的资料进行统计学分析。结果①183例患者中,37例确诊临床骨转移,146例无临床骨转移。37例骨转移患者的转移灶位置,5例位于盆腔内,3例位于盆腔外,29例位于盆腔内外。②盆腔MRI检查诊断24例骨转移,均经临床综合评价确诊为骨转移(100%,24/24)。全身骨扫描诊断27例骨转移,96.4%(27/28)经临床综合评价确诊为骨转移。其它骨转移的确诊均经临床综合诊断。③将盆腔MRI和同位素骨扫描的结果进行比较,盆腔MRI检查未见明确骨转移灶的患者共159例,其中仅有4例患者(4/159,2.52%)全身骨扫描可明确诊断骨转移。④评价2种影像检查方法对全身骨转移的预测和诊断效果,盆腔MRI对全身骨转移预测的敏感性、特异性和准确性分别为78.38%、87.0%和85.25%;全身骨扫描对骨转移的诊断敏感性、特异性和准确性分别为94.59%、62.33%和68.85%。MRI的特异性和准确性高于同位素骨扫描(χ2=23.458,P=0.000;χ2=13.906,P=0.000),同位素骨扫描的敏感性高于MRI(χ2=4.163,P=0.041)。结论盆腔MRI也可用作前列腺癌全身骨转移的诊断。当盆腔MRI检查未见骨转移灶时,发生全身骨转移的机会较低。Objective To investigate the diagnostic efficacy of MRI and bone scintigraphy in the detection of bone metastasis from prostate cancer. Methods One hundred and eighty - three patients suspected of prostate cancer were recruited in this study. All the patients were examined by pelvic MRI and bone scintigraphy. According to the integragted clinical diagnosis, the patients were categorized as metastastic group and non - metastatic group. SPSS 11.0 was used to analyze the data. Results Bone metastasis were identified in 37 of the 183 patients. In the 24 patients whose MRI results demonstrated bone metastasis, all of them were convinced of bone metastasis （ 24/24,100% ）. In the 159 patients whose MRI results revealed no bone metastasis,only 4 of them （4/159,2.52%） were detected bone metastasis by bone scintigraphy . The sensitivity , specificity and accuracy of MRI in the detection of bone metastasis was 78.38% , 87.0% and 85.25% , respectively . The sensitivity, specificity and accuracy of bone scintigrapy in the detection of bone metastasis was 94.59% , 62.33% and 68. 85% , respectively. The specificity and accuracy of MRI in the prediction of bone metastasis were higher than that of bone scintigraphy （X^2 = 23. 458, P = 0. 000 ;X^2 = 13. 906, P = 0. 000 ） , whereas the sensitivity of bone scintigraphy in the detection of bone metastasis was higher than that of MRI （X^2 =4. 163 ,P =0. 041 ）. Conclusion With the negative findings of the pelvic MRI, the probability of bone metastasis diag- nosed by bone scintigraphy was fairly low. So even with the limitation range of the pelvic MRI examination, it is useful in the prediction of bone metastasis from prostate cancer.

关 键 词：前列腺癌 骨转移 磁共振成像 骨扫描 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]