背景抑制扩散加权成像与核素骨扫描在恶性肿瘤骨转移病变诊断中的对照研究  

A control study between DWIBS and bone scintigraphy mapping in the diagnosis of bone metastatic diseases

作　　者：沈茜刚[1] 周良平[1] 彭卫军[1] 毛健[1] 张灵[1] 姚之丰[2] 程竞仪[2] 刘晓航[1] 丁建辉[1] 岳磊[1] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科,复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学附属肿瘤医院核医学科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2014年第3期187-196,共10页China Oncology

摘　　要：背景与目的:背景抑制扩散加权成像(diffusion-weighted whole-body imaging with background body signal suppression,DWIBS)是一种可用于全身检查的MR成像技术,可以较好地显示淋巴结及骨骼系统病变,其成像效果与PET类似。本研究旨在探讨DWIBS与核素骨扫描成像在骨转移性病变诊断中的临床应用价值。方法:36例经手术或穿刺病理证实为恶性肿瘤的患者行DWIBS及核素骨扫描检查,比较两者检出骨转移的情况,采用χ2检验,P<0.05为差异有统计学意义。结果:36例恶性肿瘤患者中,30例(共165处)发生骨转移,其中DWIBS检出26例(143处),核素骨扫描检出23例(132处),两者在检出骨转移方面差异无统计学意义(χ2=1.002,P=0.506)。DWIBS及核素骨扫描诊断骨转移的灵敏度、阳性预测值、准确度较为接近,分别为86.7%、96.3%、86.1%和76.7%、88.5%、72.2%;DWIBS诊断骨转移的特异度、阴性预测值高于核素骨扫描,分别为83.3%、55.6%和50.0%、30.0%。分析DWIBS和核素骨扫描检出骨转移的部位,两者的检出率分别为86.7%(143/165)、80.0%(132/165),差异无统计学意义(χ2=2.640,P=0.104);但DWIBS在检出骨盆及四肢长骨转移方面优于核素骨扫描,且两者差异均有统计学意义(χ2=6.783和7.636,P=0.023和0.016)。结论:运用DWIBS扫描技术可有效检出骨转移性病灶,且与核素骨扫描具有较好的一致性,有望在临床上推广应用。Background and purpose： Diffusion-weighted whole-body imaging with background body signal suppression （DWIBS） can be used for MR imaging systemic examination, especially the lymph node and bone diseases can be clear, and the imaging result is similar with PET. The aim of this study was to compare the value of clinical application in the diagnosis of malignant metastatic osteopathic between DWIBS and bone scintigraphy mapping. Methods： Thirty-six specimens confirmed with malignant tumors by the pathology of operation or biopsy underwent both DWIBS imaging and bone scintigraphy mapping, chi-square test was used for comparing the detection results of bone metastasis by this two imaging methods. Results： Thirty （165 positions in all） of 36 malignant tumor patients were confirmed as having bone metastasis, compared that 26 patients （143 positions） with DWIBS method and 23 patients （132 positions） with bone scintigraphy mapping were detected, but there was no statistical significance between this two imaging methods （x2=1.002, P=0.506）. The sensitivity, positive predictive value （PPV） and accuracy of the detectionrate of bone metastasis were similar in DWIBS and bone scintigraphy, with 86.7%, 96.3%, 86.1% and 76.7%, 88.5%, 72.2%, respectively; but the specificity and negative predictive value （NPV） in DWIBS （83.3% and 55.6%） was higher than that of in bone scintigraphy （50.0% and 30.0%）. The detection rates of different bone metastasis with DWIBS and bone scintigraphy were 86.7% （143/165） and 80.0% （132/165）, and it was no significant difference （x2=2.640, P=0.104）; DWIBS method was better than bone scintigraphy in the detection of osseous metastasis on pelvis and limbs long bone, and there was different significant （3（2=6.783 and 7.636, P=-0.023 and 0.016）. Conclusion： DWIBS could detect bone metastatic lesions effectively, and there is fine consistency with bone scintigraphy. Therefore, DWIBS is to hope to be extended and anvlicated clinically.

关 键 词：扩散加权成像 背景抑制扩散加权成像 磁共振成像 骨转移 核素骨扫描 

分 类 号：R730.44[医药卫生—肿瘤]