CT衰减校正对脊柱病灶SPECT显像的增益价值  

Added diagnostic value of CT attenuation correction for spinal lesions in SPECT bone imaging

作　　者：余浩军[1] 张一秋[1] 李蓓蕾[1] 蔡良[1] 陈曙光[1] 石洪成[1] 

机构地区：[1]复旦大学附属中山医院核医学科、复旦大学核医学研究所、上海市影像医学研究所,上海200032

出　　处：《中华核医学与分子影像杂志》2016年第3期250-254,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：上海卫生系统先进适宜技术推广项目（2013SY008）

摘　　要：目的 探讨CTAC在提高脊柱病灶SPECT图像质量及对良恶性判断的诊断信心方面是否具有增益价值.方法 75例[男47例,女28例,年龄（56.6±12.8）岁]全身骨显像示脊柱放射性异常浓聚病灶的患者,因全身骨显像无法明确良恶性诊断行SPECT/CT显像.将脊柱病灶NACSPECT图像与CTAC SPECT图像按5分法（5分,优秀;4分,良好;3分,中等;2分,一般;1分,较差）评分,并对图像良恶性诊断信心按4分法（4分,肯定;3分,基本肯定;2分,可能;1分,无法判断良恶性）评分,以手术病理结果为“金标准”,评价CTAC对脊柱病灶SPECT显像的增益价值.采用Wilcoxon 配对符号秩和检验比较评分差异.结果 有37.3％（28/75）的患者CTAC图像质量评分较NAC图像质量评分上升,60.0％ （45/75）的患者评分不变,2.7％（2/75）的患者评分下降,CTAC对SPECT图像质量有显著改善（z=-4.747,P＜0.001）.CTAC对诊断信心评分无显著提高（z=-1.000,P＞0.05）.结论 CTAC可显著提高图像视觉质量较差的脊柱病灶SPECT图像质量,对视觉质量较好的SPECT图像意义不大;其对良恶性诊断信心无显著提升.Objective To investigate the added value of CTAC for improving image quality and diagnostic efficiency of bone imaging in SPECT/CT.Methods Seventy-five patients （47 males,28 females,（56.6± 12.8） years） with abnormal uptake in planar whole-body bone scintigraphy underwent SPECT/CTfor differentiation of malignant from benign spinal lesions.NAC and CTAC SPECT images were classified based on 5-point scale （5：excellent,4：good,3：adequate,2：suboptimal,1：inadequate）.The diagnostic confidence for both NAC and CTAC SPECT images were classified based on 4-point scale （4：definite,3：certain,2：equivocal,1：uninterpretable）.The pathological results after surgery were used as gold standard to evaluate the added diagnostic value of CTAC for spinal lesions.Wilcoxon-signed rank sum test was used for data analysis.Results CTAC improved the image quality in 37.3% （28/75） of patients,and downgraded in 2.7% （2/75） of patients.The remaining 45 patients were unchanged （60.0%,45/75）.SPECT with CTAC could significantly improve the image quality （z=-4.747,P〈0.001）,but the overall diagnostic confidence was not increased （z=-1.000,P〉0.05）.Conclusion CTAC can improve the image quality of spinal SPECT,especially useful in imaging with poorer quality,but it has no significant incremental value in diagnostic confidence.

关 键 词：脊柱疾病 诊断 鉴别 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 MDP 

分 类 号：R681.5[医药卫生—骨科学] R817.4[医药卫生—外科学]