分化型甲状腺癌骨转移:^(18)F-FDG SPECT显像能否取代全身骨显像  

Bone Metastases of Differentiated Thyroid Carcinoma:Could ^(99m)Tc-bone Scintigraphy be Substituted with Whole-body ^(18)F-FDG SPECT

作　　者：叶智轶[1] 王辉[1] 杜学亮[1] 傅宏亮[1] 

机构地区：[1]上海交通大学医学院附属新华医院核医学科,200092

出　　处：《放射免疫学杂志》2012年第5期484-487,共4页Journal of Radioimmanology

摘　　要：目的:比较18F-脱氧葡萄糖(FDG)SPECT显像和全身骨显像对于分化性甲状腺癌(DTC)骨转移灶检测能力的区别。方法:回顾性分析2005年1月～2009年1月期间接受131I治疗的DTC骨转移患者17例(男8,女9),年龄(46～82)岁。8例乳头状腺癌,9例滤泡状腺癌。7例单纯骨转移,10例合并淋巴结和/或肺转移。所有患者在接受大剂量131I治疗转移灶前2d～10d均行18F-FDG SPECT显像和99mTc-MDP全身显像。使用SPSS11.0软件对组别之间比较行χ2检验。结果:17例患者共发现70个骨转移区。18F-FDG SPECT显像的灵敏度71.34%(50/70)高于全身骨显像62.86%(44/70),但两者差异无统计学意义(t=1.17,P>0.05)。特异度和准确度18F-FDG SPECT显像97.76%(131/134)和88.73%(181/204)均高于全身骨显像91.04%(122/134)和81.37%(166/204),且差异都具有统计学意义(t=5.72,P<0.05和t=4.34,P<0.05)。结论:对于DTC骨转移的检测,18F-FDG SPECT显像的灵敏度与全身骨显像相仿,而特异度和准确度高于全身骨显像。但是,对于小部分成骨性反应为主的DTC骨转移灶,全身骨显像更为灵敏。所以,18F-FDG SPECT显像不能完全取代全身骨显像,全身骨显像对于检测DTC骨转移仍然具有临床价值,可作为18F-FDG SPECT显像的一种补充。Objective The purpose of this study was to compare 18F-FDG SPECT and 99mTc-bone scintigraphy in the detection of bone metastases of DTC.Methods In this retrospective study,17 bone metastastic DTC patients treated by radioiodine from January 2005to January 2009 were reviewed.8 males and 9 females,age range 46~82.8 had papillary carcinoma and 9 had follicular carcinoma.7 were proved clinically or pathologically to have bone metastases only and 10 have bone metastases with lymph node and/or pulmonary metastases as well.All the patients underwent both 18F-FDG SPECT and 99mTc-bone scintigraphy from 2to10 days before the radioiodine therapy to detect bone metastases.Statistical analysis was performed with SPSS11.0,and Chi-square test was used.Results There were overall 70 bone metastastic lesions confirmed in 17 patients.In evaluating the detection of bone metastases,18F-FDG SPECT showed 71.34%（50/70）sensitivity,97.76%（131/134） specificity and 88.73%（181/204）accuracy,compared with 62.86%（44/70）,91.04%（122/134） and 81.37%（166/204）,respectively,for bone scintigraphy.The sensitivity of 18F-FDG SPECT was similar to that of bone scintigraphy,this difference was not statistically significant（t=1.17,P〉0.05）.While the specificity and accuracy of 18F-FDG SPECT were statistically significantly higher than those of bone scintigraphy（t=5.72,P〈0.05）and（t=4.34,P〈0.05）individually.Conclusion This study suggested that 18F-FDG SPECT has a higher specificity and a better accuracy than that of bone scintigraphy to detect bone metastases in patients with DTC.But bone scintigraphy was superior to 18F-FDG SPECT in the detection of osteoblastic lesions.Thus bone scintigraphy should play a complementary role in detecting bone metastases with 18F-FDG SPECT and could not be replaced by it.

关 键 词：骨转移 分化型甲状腺癌 18F-FDG SPECT显像 99mTc-骨显像 

分 类 号：R742.5[医药卫生—神经病学与精神病学]