^99Tc^m-MIBI显像在^99Tc^m-MDP显像不能定性骨病灶中的应用价值  

Clinical value of ^99Tc^m-MIBI scintigraphy for bone lesions of indefinite diagnosis with ^99Tc^m-MDP bone imaging

作　　者：任佳忠 霍宗伟 王晓慧[1,4] 刘岩 张鹏[1,4] 岳宁[1] 方永存 李国梁[1,4] 吴庆伟 陈鸣陆 杨国仁 

机构地区：[1]山东大学附属山东省肿瘤医院核医学科,济南250117 [2]山东省济宁市第一人民医院放射科,272111 [3]济南大学、山东省医学科学院医学与生命科学学院,250022 [4]山东省医学科学院,济南250062

出　　处：《中华核医学与分子影像杂志》2018年第3期182-186,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：山东省自然科学基金（2016ZRC03098）;山东省医学科学院基金（2016-08,2016-25）

摘　　要：目的探讨^99Tc^m-甲氧基异丁基异腈（MIBI）双时相显像鉴别^99Tc^m-亚甲基二膦酸盐（MDP）全身骨显像不能明确良恶性的病灶的价值及其与化疗疗效的相关性。方法2014年6月至2015年11月常规^99Tc^m-MDP全身骨显像发现骨病灶（≤3个），但性质不能明确的52例肿瘤患者（男23例，女29例，中位年龄58岁），1周内再行^99Tc^m-MIBI SPECT/CT双时相（注射显像剂后10和30 min）显像。以2种以上影像检查（CT或MRI或PET/CT）和（或）随访（≥6个月）明确骨病灶的良恶性诊断，分析^99Tc^m-MIBI SPECT/CT对骨病灶的诊断效能。收集患者的同期化疗资料，对确诊为肿瘤骨转移的患者根据化疗疗效分为有效组和无效组，探讨肿瘤骨转移灶的^99Tc^m-MIBI滞留指数（RI）与肿瘤同期化疗疗效间的关系。采用两样本t检验和Spearman相关分析行统计学处理。结果共96个骨病灶，其中恶性84个，良性12个。^99Tc^m-MIBI显像对骨病灶的诊断灵敏度为96.43%（81/84），特异性为83.33%（10/12），阳性预测值为97.59%（81/83），阴性预测值为76.92%（10/13），约登指数为0.80。化疗有效组和无效组的骨转移患者RI的差异有统计学意义：-0.142±0.036与-0.384±0.067（t＝2.367，P〈0.05）。骨转移灶^99Tc^m-MIBI的RI与患者化疗疗效呈正相关（rs＝0.78，P〈0.01）。结论^99Tc^m-MIBI双时相显像对^99Tc^m-MDP骨显像不能定性骨病灶具有较高的良恶性鉴别诊断效能；骨转移灶^99Tc^m-MIBI的RI在一定程度上可预测肿瘤患者的化疗疗效。Objective To investigate the clinical value of ^99Tc^m-methoxyisobutylisonitrile （MIBI） double-phase imaging in differential diagnosis of bone lesions in tumor patients, which was indefinite in ^99Tc^m-methylene diphosphonate （MDP） bone imaging, and evaluate the correlation between 99Tcm-MIBI imaging and chemotherapy efficacy.Methods Fifty-two tumor patients （23 males, 29 females, mean age 58 years） with bone isolated lesions（≤3） found by ^99Tc^m-MDP bone scintigraphy was enrolled from June 2014 to November 2015. Since the results of ^99Tc^m-MDP imaging were indefinite, ^99Tc^m-MIBI double-phase （10 min and 30 min after injection of 99Tcm-MIBI） SPECT/CT imaging was then performed within 1 week. The final diagnosis was made according to results of more than two imaging modalities （CT, MRI, PET/CT） and/or follow-up （≥6 months）. The diagnostic efficacy of 99Tcm-MIBI SPECT/CT imaging was calculated. The clinical data of chemotherapy were also collected. Patients with bone metastasis were grouped as the treatment response. Retention index （RI） of metastatic lesions was calculated and compared between different groups using two-sample t test. The relationship between RI and chemotherapy efficacy was investigated by Spearman correlation analysis.Results A total of 12 benign lesions and 84 malignant lesions were eventually diagnosed. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and Youden index of 99Tcm-MIBI imaging were 96.43%（81/84）, 83.33%（10/12）, 97.59%（81/83）, 76.92%（10/13）, and 0.80, respectively. The RI was statistically different between complete remission （CR）＋ partial remission （PR） group and stable disease （SD）＋ progressive disease （PD） group： -0.142±0.036 vs -0.384±0.067 （t=2.367, P〈0.05）. The RI of ^99Tc^m-MIBI in bone metastases was positively correlated with the chemotherapy efficacy （rs=0.78, P〈0.01）.Conclusions 99Tcm-MIBI imaging is helpful in differential diag

关 键 词：骨肿瘤 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 99M锝甲氧基异丁基异腈 99M锝美罗酸盐 

分 类 号：R730.44[医药卫生—肿瘤]