18F-FDG PET/CT显像对宫颈癌放疗后骶骨不全骨折与转移瘤的鉴别诊断  

18F-FDG PET/CT Imaging in the Differential Diagnosis of Sacral Insufficiency Fracture After Cervical Cancer Radiotherapy and Sacral Metastasis

作　　者：张杰平[1] 林端瑜[1] 李生栩[1] 蔡志华[1] 唐明灯[1] ZHANG Jieping;LIN Duanyu;LI Shengxu;CAI Zhihua;TANG Mingdeng(Fujian Cancer Hospital&Fujian Medical University Cancer Hospital,Fuzhou 350014,China)

机构地区：[1]福建省肿瘤医院,福建医科大学附属肿瘤医院,福建福州350014

出　　处：《中国医学影像学杂志》2020年第12期952-957,共6页Chinese Journal of Medical Imaging

摘　　要：目的探讨18F-FDG PET/CT显像鉴别诊断宫颈癌放疗后骶骨不全骨折(SIF)与骶骨转移瘤的价值。资料与方法回顾性分析经临床或病理确诊的29例宫颈癌放疗后SIF患者(SIF组)及28例单发骶骨转移瘤患者(转移瘤组)的PET/CT资料,观察放疗区域内、外椎体CT值、骨折类型、最大标准化摄取值(SUVmax)、FDG摄取模式、骨质破坏模式、有无骨折线、有无软组织肿块。采用受试者工作特征(ROC)曲线分析SIF与骶骨转移瘤的最佳SUVmax临界值。结果SIF组放疗区域内、外椎体CT值分别为(25.1±26.6)Hu和(90.3±32.5)Hu,差异有统计学意义(t=8.354,P<0.001);SIF组骨折类型为B1型9例,B2型2例,A1型11例,A2型7例,合并骶骨外骨折11例。SIF组与转移瘤组SUVmax分别为3.0±1.2和9.1±4.2,差异有统计学意义(t=7.390,P<0.001);FDG摄取模式、骨质破坏模式、折线及软组织肿块差异均有统计学意义(P均<0.01)。ROC分析显示诊断转移瘤的SUVmax最佳阈值为5.0,敏感度为83.2%,特异度为98.5%。结论SIF的典型18F-FDG PET/CT表现为平行于骶髂关节的骨折线伴轻中度FDG摄取,PET/CT显示病变的FDG摄取特征及形态学改变与转移瘤的鉴别诊断有重要价值。Purpose To investigate the value of 18F-FDG PET/CT imaging in the differentiation of sacral insufficiency fracture(SIF)after cervical cancer radiotherapy from sacral metastasis.Materials and Methods Twenty-nine patients with SIF who received cervical cancer radiotherapy and 28 patients with sacral metastasis were retrospectively analyzed,all patients were clinically or pathologically diagnosed.CT value of vertebral in irradiation field and out of irradiation field,type of bone fracture,SUVmax,FDG uptake pattern,bone destruction pattern,presence or absence of fracture lines and presence or absence of soft tissue masses were observed.Receiver operating characteristic curve(ROC)was used to analyze the optimal SUVmax threshold of SIF and sacral metastasis.Results The CT value of vertebral in irradiation field and out of irradiation field in SIF group were(25.1±26.6)Hu and(90.3±32.5)Hu,respectively,with statistical difference(t=8.354,P<0.001).The type of bone fracture in SIF group was:9 cases for type B1,2 cases for type B2,11 cases for type A1,7 cases for type A2,and 11 cases for combined extrasacral fractures.The SUVmax of SIF group and the sacral metastasis group were 3.0±1.2 and 9.1±4.2,respectively,with significant difference(t=7.390,P<0.001).FDG uptake pattern,bone destruction pattern,fracture lines and soft tissue masses showed statistical difference between the two groups(P<0.01).ROC analysis showed that the optimal threshold of SUVmax for the diagnosis of metastatic tumors was 5.0,the sensitivity and specificity were 83.2% and 98.5%,respectively.Conclusion Fracture line parallel to sacroiliac joints with mild 18F-FDG uptake are typical 18F-FDG PET/CT findings of sacral insufficiency fracture;the FDG uptake characteristics and morphological changes of the lesions are of great value in the differential diagnosis of sacral metastasis.

关 键 词：骨折 应力性 骶骨 宫颈肿瘤 肿瘤转移 体层摄影术 螺旋计算机 正电子发射断层显像术 氟脱氧葡萄糖F18 诊断 鉴别 

分 类 号：R730.44[医药卫生—肿瘤] R737.33[医药卫生—临床医学]