^(18)F-FDG PET/CT、^(99m)Tc-MDP全身骨显像及其联合CT对肺癌骨转移的诊断价值比较  

Comparison of the diagnosis value of ^(18)F-FDG PET/CT with ^(99m)Tc-MDP bone scintigraphy or bone scintigraphy combined CT in the detection of bone metastases of lung cancer

作　　者：周建明[1] 毛朝明[1] 朱丽[2] 高健青[1] 殷瑞根[2] 张礼荣[2] 赵亮[2] 孔倩倩[2] 李林[1] 

机构地区：[1]江苏大学附属医院核医学科,江苏镇江212001 [2]江苏大学附属医院影像科,江苏镇江212001

出　　处：《医学影像学杂志》2017年第10期1902-1907,共6页Journal of Medical Imaging

摘　　要：目的探讨^(18)F-FDG PET/CT,^(99m)Tc-MDP全身骨显像(BS)及BS联合CT这三种方法对肺癌骨转移诊断价值的比较。方法回顾性分析2014年1月~2016年8月间行^(18)F-FDG PET/CT及BS检查并经病理证实的56例肺癌患者,将BS与^(18)F-FDG PET/CT同机CT图像进行联合诊断,以病理及临床随访为诊断依据,比较BS、BS联合CT及^(18)F-FDG PET/CT对肺癌骨转移的诊断价值。数据分析采用χ~2检验,P﹤0.05为差异有统计学意义。结果 56例患者中骨转移28例共138处骨转移灶。基于患者,^(18)F-FDG PET/CT(96.4%及94.6%)与BS联合CT(89.3%及91.1%)诊断肺癌骨转移的特异性及准确性均高于BS(60.7%及75.0%)(均P<0.01与均P<0.05),^(18)F-FDG PET/CT(92.9%)与BS(89.3%)灵敏度差异无统计学意义。^(18)F-FDG PET/CT与BS联合CT之间差异均无统计学意义。基于骨转移灶,^(18)F-FDG PET/CT对骨转移灶的检出率(92.0%)高于BS联合CT(79.0%)(X^2=9.473,P<0.01),BS联合CT高于BS(68.1%)(X^2=4.191,P<0.05)。^(18)F-FDG PET/CT对CT无形态异常(骨髓转移)及溶骨性转移灶的检出率高于BS联合CT(X^2=16.261及15.300,均P<0.01),BS联合CT对溶骨性转移灶的检出率高于BS(X^2=6.711,P<0.01),BS对成骨性转移灶的检出率高于^(18)F-FDG PET/CT(X^2=8.892,P<0.01)。^(18)F-FDG PET/CT更容易发现位于胸椎、骶椎、骨盆及股骨的转移灶。结论^(18)F-FDG PET/CT与BS联合CT诊断肺癌骨转移的价值优于BS,^(18)F-FDG PET/CT能更早发现BS联合CT无法检出的骨髓及小的溶骨性转移灶。Objective To investigate the diagnostic value of^18F-FDG PET/CT,compared with^99mTc-MDP bone scintigraphy or combined CT for the detection of bone metastases in patients with lung cancer. Methods We retrospectively analyzed 56 patients（ 33 men,23 women,median age 60. 0 years）. All specimens conrmed by the pathology underwent both-（18）F-FDG PET/CT and bone scintigraphy from January 2014 to August 2016. We combined BS with CT which was used for^18F-FDG PET/CT and joint pathology and clinical follow-up diagnosis to compare the diagnostic value of bone scintigraphy,or combined CT with^18FFDG PET/CT. Chi-square test was used for comparing results of bone metastasis by this three methods. P〈0. 05 was considered statistically significant. Results Of the 56 patients,28 patients with 138 metastatic bone lesions were diagnosed. Based on patients,the specificity and accuracy for^18F-FDG PET/CT（ 96. 4% and 94. 6%） and BS combined CT（ 89. 3% and 91. 1%）were higher than BS（ 60. 7% and 75. 0%） in diagnosisof bone metastases of lung cancer（ all P〈0. 05）,but the sensitivity of^18F-FDG PET/CT（ 92. 9%） and BS（ 89. 3%） had no statistical significance. The difference between^18F-FDG PET/CT and BS combined CT had no statistical significance. Based on metastatic bone lesions,the relevance ratio of bone metastases by^18F-FDG PET/CT（ 92. 0%） were higher than BS combined CT（ 79. 0%）（χ^2= 9. 473,P〈0. 01）. Meantime,the relevance ratio of bone metastases by BS combined CT（ 79. 0%） was higher than BS（ 68. 1%）（ χ^2= 4. 191,P〈0. 05）. The relevance ratio of no abnormal morphology（ bone marrow metastases） and osteolytic metastases by^18F-FDG PET/CT were higher than BS combined CT（ χ^2= 16. 261 and 15. 300,P〈0. 01）. The relevance ratio of osteolytic metastases by BS combined CT was higher than BS（χ^2=6. 711,P〈0. 01）. The relevance ratio of osteoblastic metastases by BS was higher than^18F-FDG PET/CT（ χ^2= 8. 892,P〈0. 01）. We found^18F-FDG PET/CT was easier t

关 键 词：肺癌 骨转移 正电子发射断层显像术 体层摄影术 X线计算机 骨扫描 

分 类 号：R814.42[医药卫生—影像医学与核医学] R734.2[医药卫生—放射医学]