PACS系统对^(99m)Tc-MDP全身骨显像诊断肿瘤骨转移的增益价值  

The added value of picture archiving and communication system(PACS)for 99mTc-MDP whole-body bone scan in diagnosing bone metastases

作　　者：童良前[1] 陈璟[1] 姜圣男[1] 陈春荣[1] 林婉[1] 随燕芳[1] 

机构地区：[1]海口市人民医院核医学科,海口570208

出　　处：《放射学实践》2015年第10期1049-1052,共4页Radiologic Practice

基　　金：海口市重点科技计划项目(2014-070);海口市人民医院院内项目(2014年度)PACS系统对99mTc-MDP全身骨显像诊断肿瘤骨转移的增益价值

摘　　要：目的:探讨PACS系统对99mTc-MDP全身骨显像诊断肿瘤骨转移的增益价值。方法:搜集病理证实为恶性肿瘤并且99mTc-MDP全身骨显像发现有阳性病灶的患者240例,两位有经验的核医学医师共同以核医学影像处理系统及PACS系统对全身骨显像的骨骼病灶做出诊断,诊断结果分为良性、可能良性、难以确定、可能骨转移、骨转移5个等级,分别用评分1~5表示。最终诊断以病理、影像检查和临床随访结果为依据。采用SPSS18.0软件,以ROC曲线及χ2检验比较两种报告系统的诊断效益,对比两种报告系统的特异度、敏感度、总的符合率、阳性预测值及阴性预测值,从定性诊断方面评价PACS系统对全身骨显像诊断肿瘤骨转移的增益价值。结果:240例患者中男127例,女113例,年龄21~85(45.2±20.6)岁。PACS系统及核医学影像处理系统诊断的ROC曲线下面积分别为0.958及0.890,两者对比差异有显著统计学意义(Z=2.66,P<0.01)。PACS系统及核医学影像处理系统诊断的敏感度分别为87.7%(93/106)和76.4%(81/106,χ2=4.617,P=0.032<0.05),特异度分别为88.1%(118/134)和71.6%(96/134,χ2=11.255,P=0.001<0.01),总的符合率分别为87.9%(211/240)和77.1%(185/240,χ2=9.755,P=0.002<0.01),阳性预测值分别为91.2%(93/102)和81.0%(81/100,χ2=4.380,P=0.036<0.05),阴性预测值分别为95.2%(118/1124)和87.3%(96/110,χ2=4.641,P=0.031<0.05)。结论:相对于核医学影像处理系统,PACS系统明显提高了99mTc-MDP全身骨显像对肿瘤骨转移诊断的准确性,具有增益价值。Objective：To investigate the added value of picture archiving and communication system（PACS）for99mTc-MDP whole-body bone scan（WBBS）in diagnosing bone metastases.Methods：240patients with pathologically proved malignant tumors were recruited in this study.They all had abnormal 99mTc-MDP WBBS results.The 99mTc-MDP WBBS images were interpreted by two experienced nuclear medicine physicians in nuclear medicine report system and PACS,respectively.The appearances were divided into five grades from grade 1（benign lesions）to grade 5（metastatic lesions）.The final diagnosis of each bone lesion was based on pathological confirmation,other image data or follow-up.Receiver operating characteristic（ROC）curve and Chi-square test were used for data analysis.Results：The area under ROC curve（AUC）of PACS was higher than that of nuclear medicine report system（Z=2.66,P〈0.01）.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value for the diagnosis of bone metastases by 99mTc-MDP WBBS in PACS and nuclear medicine report system were 87.7%（93/106）and 76.4%（81/106）（χ2=4.617,P=0.032）,88.1%（118/134）and 71.6%（96/134）（χ2=11.255,P=0.001）,87.9%（211/240）and 77.1%（185/240）（χ2=9.755,P=0.002）,91.2%（93/102）and 81.0%（81/100）（χ2=4.380,P=0.036）,95.2%（118/1124）and 87.3%（96/110）（χ2=4.641,P=0.031）,respectively.Conclusion：PACS can help improve the efficacy of 99mTc-MDP WBBS for the diagnosis of bone metastases.

关 键 词：体层摄影术 发射型计算机 单光子 肿瘤转移 图像处理 计算机辅助 

分 类 号：R730.44[医药卫生—肿瘤]