乳腺癌患者骨病灶SPECT／CT融合显像的临床价值  

The clinical value of SPECT/CT fusion imaging in the diagnosis of bone metastasis of breast cancer

作　　者：樊孝廉[1] 鲁胜男[1] 古炎发[1] 张爱芳[1] 

机构地区：[1]南方医科大学附属南海医院,佛山市南海区人民医院核医学科,528200

出　　处：《国际放射医学核医学杂志》2013年第4期221-224,共4页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的探讨SPECT／CT融合显像诊断与鉴别乳腺癌患者全身骨显像放射性异常浓聚灶的临床价值。方法对25例乳腺癌患者的^99Tc^m-MDP全身骨显像显示的骨异常放射性浓聚灶行SPECT／CT融合显像。4-8个月后再次行全身骨显像及SPECT／CT融合显像复查。图像由两名有经验的核医学科医师独立分析，部分CT图像由有经验的放射科医师分析指导。结果在25例乳腺癌患者的37个异常放射性浓聚灶中，确定29（29／37，78．38％）个病灶为骨转移灶，其中有2个椎体病灶在初次检查中判读为良性病灶；8（8／37，21．62％）个病灶为良性病灶，其中1个肋骨病灶在初次检查中判读为骨转移灶，比较全身骨显像和SPECT／CT融合显像，二者之间差异有统计学意义（X^2=6．975，P〈0．05）。骨转移灶主要分布于椎骨及肋骨。全身骨显像和SPECT／CT融合显像的诊断灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为82．76％、75．00％、92．31％、54．55％、81．08％和93．10％、87．50％、96．43％、77．78％、91．89％。采用受试者操作特性曲线（ROC）进行分析，结果：全身骨显像曲线下面积为O．860±0．056，SPECT／CT融合显像曲线下面积为0．974±0．020。SPECT／CT融合显像曲线下面积大于全身骨显像曲线下面积，两者之间差异具有统计学意义（X^22=9．924，P〈0．001）。结论SPECT／CT融合显像较全身骨显像能更好地鉴别出乳腺癌骨病灶的性质，能够提高诊断准确率，具有重要的临床价值；必要时应在4-8个月后复查SPECT／CT。Objective To evaluate the clinical value of SPECT/CT fusion imaging in the diagnosis and differential diagnosis the characteristic of the whole body bone scan radioactive hot lesions in patients with breast cancer. Methods The abnormal radioactive hot lesions of whole body bone scan in 25 patients with breast cancer underwent SPECT/CT fusion imaging immediately. Another whole body bone scan and SPECT/CT fusion imaging were carried out 4 to 8 months later in all these patients. The whole body bone scan images, SPECT/CT images and fusion images were analyzed independently by two experienced nuclear medicine physicians and some of the equivocal CT images were analyzed by an experienced radiologist. Results Among all the 37 abnormal radioactive hot bone lesions, 29 （29/37, 78.38% ） lesions were confirmed metastatic lesions, including 2 vertebral lesions classified as benign lesions on the basis of the firsf examinations data; and 8 lesions were benign, including a rib lesion classified as benign lesion according to the first examinations data. The difference between whole body bone scan and SPECT/CT examination was statistically significant （X^2=6.975, P〈0.05）. The bone metastases are located mainly in spine and ribs. The sensitivity, specificity, positive and negative predictive values, and accuracy of whole-body bone scan and SPECT/CT fusion imaging were 82.76%, 75.00%, 92.31%, 54.55%, 81.08% and 93.10%, 87.50%, 96.43%, 77.78%, 91.89%, respectively. The area under the receiver operating characteristics curve was 0.860±0.056 for whole body bone scan and 0.974±0.020 for SPECT/CT. The area under the curve for SPECT/CT was significantly larger compared with the whole body bone scan（X^2=9.924, P〈0.001 ）. Conclusions SPECT/CT fusion imaging is better than whole body bone scan alone to characterize the abnormal bone radioactive hot lesions and it can improve the accuracy of diagnosis. The patients should repeat the modality 4 to 8 months later if necessary.

关 键 词：乳腺肿瘤 肿瘤转移 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 

分 类 号：R730.44[医药卫生—肿瘤]