FDG PET/CT的同机CT在偶发肋骨骨折与转移瘤中的鉴别诊断价值  

Value of integrated PET-CT system for differential diagnosis between incidental rib fractures and bone metastases

作　　者：王剑杰[1] 陈燕[1] 蒲朝煜[1] 

机构地区：[1]武警总医院核医学科,北京100039

出　　处：《医疗卫生装备》2016年第4期83-87,共5页Chinese Medical Equipment Journal

摘　　要：目的:研究肋骨转移瘤与骨折的氟脱氧葡萄糖(fluorodeoxyglucose,FDG)PET/CT代谢特征,探讨同机CT在鉴别肋骨良恶性病变中的价值。方法:回顾性分析行全身FDG PET/CT显像的恶性肿瘤患者44例,共检出肋骨摄取增高病灶67个,最终以病理结果或系列影像学随访资料作为诊断标准。测量所有病灶的最大标准化摄取值(maximal standardized uptake value,SUVmax)进行半定量分析,并对良恶性病灶PET及同机CT表现进行影像学分型。结果:67个肋骨PET摄取阳性病灶中偶发骨折30个,骨转移灶37个。以SUVmax≥2.5作为PET诊断恶性病灶标准,PET以及PET联合同机CT诊断肋骨转移灶的敏感度、特异度、准确度分别为89.2%、60.0%、76.1%和93.2%、80.0%、88.1%;PET联合同机CT诊断肋骨恶性病变的准确度高于单独PET,二者差异无显著性(χ2=3.248,P=0.071)。PET图像呈节段性摄取,同机CT伴有溶骨性或成骨性改变是肋骨转移灶的相对特征性表现;而PET图像呈局灶性摄取,CT上出现骨折线或骨痂是肋骨骨折的特异性表现。结论:单纯使用SUVmax区分肋骨良恶性病灶准确度有限,PET/CT的同机CT影像学特征分析对提升诊断准确度具有重要应用价值。Objective To study the metabolic manifestations of fluorodeoxyglucose in incidental rib fractures and rib metastases by integrated PET-CT system so as to determine its value for the differential diagnosis between benign and malignant rib lesions. Methods Totally 44 patients suffering from malignant tumor had their FDG PET/CT images analyzed retrospectively, with 67 positive lesions on ribs detected, who were confirmed by pathological examination and follow-up data. The maximum standardized uptake values （SUVmax） of all lesions were measured for semi-quantitative analyses and imaging classification of benign and malignant lesions based on PET-CT manifestations.Results There were 30 benign lesions and 37 bone metastases among 67 lesions. With PET diagnosis criteria for malignant lesion set as SUVmax not less than 2.5 ,the values of sensitivity, specificity and accuracy of PET and integrated PET-CT system were 89.2%, 60.0%, 76.1% and 93.2%, 80.0%, 88.1% respectively. Integrated PET-CT system had a higher accuracy than PET when used for diagnosing malignant rib lesions, while there was no significant difference between them （X2=3.248, P=0.071）. The specific manifestations of rib metastasis included segmental intake by PET, and osteolytic or osteogenic lesions by integrated PET-CT system; the specific manifestations of rib fracture involved in focal intake by PET, and fracture line or callus by CT. Conclusion SUVmax is not so accurate for diagnosing benign and malignant rib lesions, and the manifestations by integrated PET-CT system are of great value for the diagnosis.

关 键 词：氟脱氧葡萄糖 肿瘤转移 正电子发射断层显像术 体层摄影术/X线计算机 诊断/鉴别 

分 类 号：R683.1[医药卫生—骨科学] R738[医药卫生—外科学] R730.44[医药卫生—临床医学]