全身MRI与核素骨扫描对骨转移瘤诊断价值的对照研究  

Whole-body MRI for detecting osseous metastases： comparison with bone scintigraphy

作　　者：鲁珊珊[1] 王德杭[1] 李永军[2] 冯阳[1] 周敏林[3] 刘许慧[1] 

机构地区：[1]南京医科大学第一附属医院放射科,210029 [2]南京医科大学第一附属医院核医学科,210029 [3]南京医科大学流行病与卫生统计学系

出　　处：《中华放射学杂志》2011年第5期459-462,共4页Chinese Journal of Radiology

摘　　要：目的评价全身MRI对骨转移瘤的诊断价值。方法对30例经病理证实的恶性肿瘤患者在2周内分别进行全身MRI及核素骨显像（BS），采取临床资料同常规MRI、CT等多种影像资料结合分析，辅以必要的随访复查为“金标准”，分别以30例患者和270个部位为单位进行分析。使用McNemar检验比较两者对骨转移瘤诊断的敏感度、特异度。结果30例患者中，“金标准”诊断27例患者存在骨转移，全身MRI检出25例，2例假阴性，无假阳性患者；BS检出27例阳性患者，其中2例为假阳性。以病例为单位，两者的敏感度均为92．6％（25／27），特异度分别为100％（3／3）及33．3％（1／3）。ROC曲线下面积分别为0．9630及0．6296，差异无统计学意义（P〉0．05）。以病灶部位为单位统计显示全身MRI的敏感度、特异度分别为90．8％（108／119）、98．0％（148／151），高于骨扫描的70．6％（84／119）、90．7％（137／151）（P值均〈0．01）。全身MRI的ROC曲线下面积为0．9438，大于Bs的0．8066（P〈0．01）。全身MRI同时发现3例患者存在脑转移，4例患者存在肺转移，4例患者存在肝转移。结论全身MRI对骨转移瘤的综合诊断能力较BS好，具有一定的临床应用价值。Objective The aim of the study was to evaluate the reliability of whole-body MRI （ WB- MRI） in detecting osseous metastases. Methods Thirty patients verified with malignant tumor by histology were enrolled. All the patients underwent WB-MRI and bone scintigraphy （BS） with a two week interval. Clinical information, conventional MRI and CT images, and follow-up data were collected as gold standard for the diagnosis of bone metastases. The data of 30 patients and 270 segments as study unit respectively were analyzed. The sensitivity and specificity between WB-MRI and BS were compared with McNemar test. Results Bone metastases were confirmed in 27 of 30 patients by gold standard. Twenty-five patients with bone metastases were detected by WB-MRI and no false-positive eases. Twenty-seven patients with bone metastases were found by BS but having two false-positive cases. With patients as study unit, the diagnostic sensitivity of WB-MRI and BS were both 92.6% （25/27） and the specificity were 100% （3/3） and 33.3% （ 1/3 ） , respectively. The area under ROC curve of WB-MRI and BS were 0. 9630 and 0. 6296, respectively （P〉0. 05）. With segments as study unit, 119 bone metastases segments were confirmed. The diagnostic sensitivity of WB-MRI and BS were 90. 8% （108/119） and 70. 6% （ 84/119 ） （ P 〈 0. 01 ）, while the specificity were 98.0% （ 148/151 ） and 90. 7% （ 137/151 ） , respectively （ P 〈 0. 01 ）. The area under ROC curve of WB-MRI and BS were 0. 9438 and 0. 8066. The former was obviously higher than the latter （ P 〈 0. 01 ）. Meanwhile, by WB-MRI, 3 cases coexisting with brain metastases, 4 cases with lung metastases, and 4 cases with hepatic metastases were found. Conclusion WB-MRI was a good tool for screening osseous metastases.

关 键 词：磁共振成像 放射性核素显像 肿瘤转移 骨肿瘤 

分 类 号：R738[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R817.4