^18F-FDG PET／CT诊断恶性肿瘤骨转移的应用价值  

Bone metastasis in malignancy： the diagnostic role of ^18F-FDG PET/CT

作　　者：刘宁波[1] 马莉[2] 杨国仁[2] 李明焕[3] 胡漫[3] 韦光胜[3] 付正[2] 于金明[3] 

机构地区：[1]天津医科大学肿瘤医院放疗科,300060 [2]山东省肿瘤医院PET/CT中心 [3]山东省肿瘤医院特需一科

出　　处：《中华核医学杂志》2009年第4期230-233,共4页Chinese Journal of Nuclear Medicine

基　　金：国家高技术研究发展计划（2007AA02Z437）

摘　　要：目的评价^18F-脱氧葡萄糖（FDG）PET／CT检测恶性肿瘤骨转移的应用价值。方法回顾性分析经^18F-FDG PET／CT诊断的689例恶性肿瘤患者的资料，按颈椎、胸椎、腰椎、骶尾椎、骨盆、肩胛骨和锁骨、长骨、胸骨、肋骨及颅骨将机体骨骼分为10个区域，记录每个区域的骨转移情况。根据同机CT进一步区分转移灶的病变性质（破骨性或成骨性），比较同机CT、^18F-FDG PET及^18F-FDG PET／CT诊断骨转移的灵敏度、特异性及准确性。计算阳性病灶的最大标准摄取值（SUVmax）。患者不同性别间年龄差异采用χ^2检验，诊断率的比较采用MeNemar检验。结果共有91例患者442个区域被确定有骨转移，PET／CT诊断骨转移患者的灵敏度、特异性和准确性分别为94．5％（86／91）、97．8％（585／598）和97．4％（671／689），高于同机CT的79．1％（72／91），91．8％（549／598）和90．1％（621／689）（χ^2=20．049，148．890，168．792，P：0．000）；PET／CT诊断病灶骨转移的灵敏度、特异性和准确性分别为95．0％（420／442），97．2％（455／468）和96．2％（875／919），高于同机CT的81．0％（358／442），90．4％（423／468）和85．8％（781／910）（χ^2=98．673，125．691，220．375，P=0．000）。同机CT共诊断出99个成骨性和197个破骨性病变。PET真阳性病灶SUVmax为6．7±3．0，假阳性病灶SUVmax为3．7±1．3（χ^2=463．120，P=0．000）；成骨性病变SUVmax为4．9±2．0，破骨性病变SUVmax为7．4±3．1（χ^2=327．175，P：0．000）。结论同机CT和^18F-FDG PET图像的结合提高了PET／CT诊断恶性肿瘤骨转移的能力；同机CT能精确定位病变，并可区分转移病灶的成骨或破骨性质。Objective The aim of this retrospective study was to understand the role of ^18 F-fluorodeoxyglucose （FDG） PET/CT in detecting bone metastasis in various cancers. Methods Six hundred and eighty-nine cancer patients who had ^18F-FDG PET/CT were included. The diagnosis of bone metastasis was based on matched findings of FDG-avid lesion on PET and characteristic morphological changes on CT. The sensitivity, specificity and accuracy of CT, and PET/CT were calculated and the results were statistically analyzed （ McNemar test）. Results Ninety-one patients with 442 regions were diagnosed to have bone metastases. On patient base analysis, the sensitivity, specificity, and accuracy of hybrid CT for detecting bone metastases were 79.1% （72/91）, 91.8% （549/598）, 90. 1% （621/689） and were 94.5% （86/91）, 97.8% （585/598）, 97.4% （671/689） for PET/CT （χ^2 = 20. 049, 148. 890, 168. 792, all P = 0. 000）. On lesion base analysis, the sensitivity, specificity, and accuracy of hybrid CT for detecting bone metastases were 81.0% （358/442）, 90.4% （423/468）, 85.8% （781/910） and were 95.0% （420/442）, 97.2% （455/468）, 96.2% （875/910） for PET/CT （χ^2 = 98. 673, 125. 691, 220. 375, all P = 0. 000）. The maximum standardized uptake value （ SUVmax ） of PET true positive and false positive lesions were 6.7± 3.0 and 3.7 ±2. 3 respectively （χ^2= 463. 120, P = 0.000）. The SUVmax of osteoblastic and osteolytic lesions were 4.9 ±2.0 and 7.4±3.1, respectively （χ^2 =327. 175, P =0.000）. Conclusions It is worth noting that ^18F-FDG PET/CT is a novel tool to evaluate bone metastasis and its performances due to the combination of PET and CT. Hybrid CT has a high value in providing precise location of the metastatic sites.

关 键 词：肿瘤转移 骨疾病 体层摄影术 发射型计算机 体层摄影术 X线计算机 脱氧葡萄糖 

分 类 号：R686[医药卫生—骨科学]