^(99m)Tc-MDPSPECT/CT融合显像半定量分析对乳癌骨转移的诊断价值  

VALUE OF SEMI-QUANTITATIVE ANALYSIS OF ^(99m)Tc-MDP SPECT/CT FUSION IMAGES IN DIAGNOSIS OF BONE METASTASES FROM BREAST CANCER

作　　者：裴妮慧 柳炳吉[1] 孔宁宁[1] 袁明刚[1] 赵莉[1] 于华[1] PEI Nihui;LIU Bingji;KONG Ningning;YUAN Minggang;ZHAO Li;YU Hua(Department of Nuclear Medicine, the Second Affiliated Hospital of Qingdao University Medical College, Qingdao 266042, Chin)

机构地区：[1]青岛大学医学院第二附属医院核医学科,山东青岛266042

出　　处：《齐鲁医学杂志》2017年第5期520-523,共4页Medical Journal of Qilu

基　　金：青岛市医药科研指导计划项目(2014WJ-ZD082)

摘　　要：目的探讨^(99m)Tc-MDP SPECT/CT融合显像半定量分析法对乳癌骨转移诊断价值。方法收集^(99m)Tc-MDP全身骨显像发现有单发放射性浓聚灶的乳癌病人42例,并对单发浓聚部位行SPECT/CT融合显像。采用感兴趣区(ROI)技术分别勾画并计算平面显像及断层融合显像浓聚灶的平均放射性计数(T_3h),采用同样方法得到对侧或相邻部位正常骨骼的平均放射性计数(N_3h),并分别计算出平面显像与断层显像的放射性摄取比值H1(T_3h/N_3h)、H2(T_3h/N_3h),应用受试者工作特征(ROC)曲线技术,获取乳癌单发浓聚灶良恶性病变的最佳诊断界值点(H),验证其与临床最终诊断结果的一致性。结果以平面半定量法测定的H1=2.12为阈值诊断乳癌单发骨病灶的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为77.3%、66.7%、64.5%、62.5%、71.4%,平面半定量法H1诊断与临床综合诊断的一致性较差(Kappa=0.329)。以SPECT/CT断层ROI半定量法测定的H2=3.20为阈值对乳癌单发骨病灶诊断的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为81.8%、83.3%、80.0%、75.0%、85.7%,SPECT/CT断层ROI半定量法H2与临床综合诊断一致性较好(Kappa=0.721)。结论 H2值是SPECT/CT骨断层显像诊断乳癌骨转移较好的半定量指标,且诊断阈值取3.20时,对乳癌骨转移诊断效能较好。Objective To investigate the value of semi-quantitative analysis of ^99mTc-MDP single photon emission computed tomography/computed tomography（SPECT/CT）fusion images in the diagnosis of bone metastases from breast cancer.Methods Forty-two patients with breast cancer who had a single bone lesion by whole-body ^99mTc-MDP bone scintigraphy were enrolled as subjects.All patients underwent SPECT/CT fusion imaging for the single bone lesion.The region-of-interest（ROI）technology was used to measure the average radiation doses to bone lesion（T3 h）and contralateral healthy bone（N3 h）on planar images and SPECT/CT images.Then the ratios of radionuclide uptake,H1（T3 h/N3 h）and H2（T3 h/N3 h）,in planar imaging and SPECT/CT imaging,respectively,were calculated.The receiver operating characteristic（ROC）curve was used to determine the optimal cutoff point H（cutoff）for the diagnosis of breast cancer with a single malignant lesion.The consistency between experimental and clinical diagnoses was evaluated.Results Using a H1 cutoff of 2.12 measured by the planar semi-quantitative method,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value for the diagnosis of breast cancer with a single bone lesion were 77.3%,66.7%,64.5%,62.5%,and 71.4%,respectively.The consistency between the H1-based planar semi-quantitative method and clinical diagnosis was poor（Kappa=0.329）.Using a H2 cutoff of 3.20 by the semi-quantitative SPECT/CT and ROI method,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value for the diagnosis of breast cancer with a single bone lesion were 81.8%,83.3%,80.0%,75.0%,and 85.7%,respectively.The consistency between the H2-based semi-quantitative SPECT/CT and ROI method and clinical diagnosis was satisfactory（Kappa=0.721）.Conclusion The H2 value is a semi-quantitative index of SPECT/CT bone tomography in the diagnosis of bone metastases from breast cancer.When the cutoff is set to 3.20,the method shows satisfacto

关 键 词：体层摄影术 发射型计算机 单光子 乳房肿瘤 放射性核素显像 

分 类 号：R445.5[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]