原发性骨肉瘤^(18)F-FDG PET/CT影像特征及预后评价  

Imaging Characteristics and Prognostic Value of ^(18)F-FDG PET/CT in Primary Osteosarcoma

作　　者：冯瑾[1] 王争明 张连娜[1] 杨芳[1] 

机构地区：[1]北京积水潭医院核医学科,北京100035 [2]解放军第二炮兵总医院PET/CT中心,北京100088

出　　处：《中国医学影像学杂志》2015年第5期377-382,387,共7页Chinese Journal of Medical Imaging

摘　　要：目的探讨骨肉瘤18F-FDG PET/CT显像的影像学特征,及其对评价骨肉瘤患者预后的价值。资料与方法回顾性分析经病理证实的30例原发性骨肉瘤患者的同机PET/CT影像学特点,获得肿瘤病灶最大标准化摄取值(SUVmax)和CT值,计算肿瘤体积;根据有无肿瘤复发、转移或死亡计算无病生存时间;比较CT表现为不同组织成分的SUVmax,分析各部位SUVmax与对应CT值的相关性及影响预后的因素。结果 28例CT表现为骨质破坏、20例斑片样或棉絮样低密度瘤骨、24例软组织肿块及16例骨膜反应均表现为18F-FDG摄取增高,17例象牙质等高密度瘤骨呈低摄取。高密度瘤骨SUVmax低于骨质破坏、低密度瘤骨、软组织肿块SUVmax(F=5.196,P<0.01)。骨质破坏、低密度瘤骨、高密度瘤骨、软组织肿块SUVmax与对应的CT值呈负相关(r=-0.315,P<0.01)。30例患者平均无瘤生存时间为(36.9±14.9)个月。Kaplan-Meier曲线分析显示,SUVmax≥9患者的无病生存时间较SUVmax<9患者长(χ2=0.696,P<0.05)。Cox回归分析显示SUVmax是影响预后的独立因素(Wald=4.213,P<0.05)。结论 18F-FDG PET/CT实现了对原发性骨肉瘤解剖结构改变和代谢变化的优势互补,结合半定量分析有助于找到复杂结构肿瘤中生物活性最高的部分,低密度/高代谢瘤骨提示高度恶性;骨肉瘤原发病灶的SUVmax越高,患者预后越差。Purpose To discuss the imaging characteristics and prognostic value of 18F-FDG PET/CT in primary osteosarcoma. Materials and Methods Thirty patients with osteosarcoma confirmed by pathology were enrolled in the study. The imaging characteristics of preoperative whole body 18F-FDG PET/CT were analyzed retrospectively. The max standard uptake values（SUVmax） and CT values of lesions were obtained, and tumor volume was calculated; disease-free survival duration was calculated according to the reoccurrence and metastasis of tumor and death; the SUVmax of different components was compared, and the SUVmax in each position was analyzed in terms of the correlation with the corresponding CT value and factors influencing the prognosis. Results CT images showed that 28 patients with primary osteosarcoma had bone destruction, 20 had ground-glass or cotton-like neoplastic bone, 24 with soft tissue mass and 16 with periosteal reaction had increased 18F-FDG uptake, and 17 with high-density neopalstic bone had low 18F-FDG uptake. The SUVmax of high-density neoplastic bone was significantly lower than that of bone destruction, low-density neoplastic bone and soft tissue mass（F=5.196, P0.01）. There was a weak negative correlation between the SUVmax of various parts such as bone destruction, low-density neoplastic bone, high-density neoplastic bone and soft tissue mass and the corresponding CT value（r=- 0.315, P0.01）. The disease free survival time was（36.9±14.9） months. The Kaplan-Meier curve analysis showed that the disease free survival time was longer in patients with SUVmax ≥ 9 than in those with SUVmax9（χ^2=0.696, P0.05）. The Cox regression analysis presented that SUVmax had independent prognostic value（Wald=4.213, P0.05）. Conclusion 18F-FDG PET/CT has advantages in presenting the anatomical structure changes and metabolic changes in primary osteosarcoma. Combined with semi-quantitative analysis of SUVmax, PET/CT can be helpful in finding out the highest biological activity part from the complex tum

关 键 词：骨肉瘤 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 预后 

分 类 号：R730.44[医药卫生—肿瘤]