MRI和骨扫描及相关因素诊断前列腺癌骨转移的价值分析  

Value of MRI and bone scintigraphy and related factors in diagnosis of prostate cancer bone metastasis

作　　者：罗丽萍 胡珊 仝慧敏 黄楠 李晓倩 李丽娜[2] 余飞燕 吴波 程艳[1] LUO Liping;HU Shan;TONG Huimin;HUANG Nan;LI Xiaoqian;LI Li′na;YU Feiyan;WU Bo;CHENG Yan(Department of Nuclear Medicine,First Hospital of Shanxi Medical University,Taiyuan 030001,China;不详)

机构地区：[1]山西医科大学第一医院核医学科,太原030001 [2]山西医科大学第一医院磁共振影像科,太原030001 [3]山西医科大学口腔医学院,太原030001 [4]山西医科大学第一医院泌尿外科,太原030001

出　　处：《实用医学杂志》2021年第10期1307-1311,共5页The Journal of Practical Medicine

基　　金：山西省卫生计生委科研课题(编号:2018045)。

摘　　要：目的探讨年龄、总前列腺特异性抗原(total prostate specific antigen,tPSA)、游离前列腺特异性抗原(free prostate specific antigen,fPSA)和Gleason评分诊断前列腺癌(prostate cancer,PCa)全身骨转移的作用,同时比较MRI及核素骨扫描对骨盆区域骨转移的诊断价值,为临床早期诊断骨转移提供有效参考。方法回顾性分析51例确诊PCa的患者资料,由骨转移病灶的临床标准诊断骨转移,并分析全身骨转移的相关因素,同时比较MRI与核素骨扫描诊断骨盆区域骨转移的价值。结果(1)51例PCa患者分骨转移组(24例)与非骨转移组(27例),骨转移组tPSA、fPSA和Gleason评分明显高于非骨转移组(P<0.05)。当tPSA、fPSA取界值68.59、6.42 ng/mL时,诊断骨转移的敏感度和特异度最佳(分别为75.00%、81.50%和83.30%、81.50%)。(2)分析骨盆区域分为骨转移组22例和非骨转移组29例,MRI、核素骨扫描及二者联合诊断骨转移的敏感性、特异性、准确度分别为86.36%、93.10%、90.20%(P<0.05)和90.91%、86.21%、88.24%(P<0.05)及94.45%、79.31%、86.27%(P<0.05)。结论(1)tPSA、fPSA和Gleason评分是诊断PCa全身骨转移的危险因素,数值升高对预测骨转移有很好的指示意义,特别是当tPSA、fPSA取界值68.59、6.42 ng/mL时诊断效能最佳;(2)对骨盆区域研究发现MRI诊断PCa骨转移的特异性最高,与核素骨扫描联合诊断时敏感性最高,表明两者的联合使用可实现优势互补,有助于PCa骨转移的早期诊断。Objective To explore the role of age,total prostate specific antigen(tPSA),free prostate specific antigen(fPSA)and Gleason scores in the diagnosis of systemic bone metastasis of prostate cancer(PCa),and to compare the diagnostic value of MRI and bone scintigraphy in pelvic area bone metastasis to provide refer⁃ence for early diagnosis of bone metastasis.Methods A total of 51 patients with PCa were selected.The results of bone metastases were determined by the clinical criteria of bone metastases lesions.The related factors of whole body bone metastasis were analyzed,and the diagnosis value of pelvic area bone metastasis with MRI and bone scintigraphy were compared.Results(1)Fifty⁃one PCa patients were divided into bone metastasis group(n=24)and non⁃bone metastasis group(n=27).The tPSA,fPSA,and Gleason scores of bone metastasis group were sig⁃nificantly higher than those of non⁃bone metastasis group(P<0.05).When the cut⁃off values of tPSA and fPSA were 68.59 ng/mL and 6.42 ng/mL,the sensitivity and specificity of diagnosing bone metastasis were the best(75.00%,81.50%and 83.30%,81.50%,respectively).(2)According to pelvic area analysis,patients were divided into bone metastasis group(n=22)and non⁃bone metastasis group(n=29).The sensitivity,specificity and accuracy of MRI,bone scintigraphy and their combined diagnosis of bone metastasis were 86.36%,93.10%,90.20%(P<0.05)and 90.91%,86.21%,88.24%(P<0.05)and 95.45%,79.31%,86.27%(P<0.05),respec⁃tively.Conclusion(1)The tPSA,fPSA and Gleason scores are risk factors for definitive PCa systemic bone metastasis.Increased values are a good indication of predicting bone metastasis,especially when the cut⁃off value of tPSA and fPSA are 68.59 ng/mL and 6.42 ng/mL respectively,the diagnosis is the best.(2)The study of the pelvic area found that MRI has the highest specificity for diagnosing PCa bone metastasis,and the highest sensitivity when combined with bone scintigraphy,indicating that the combination of the two can achieve complementary advantages and contrib

关 键 词：前列腺癌 前列腺特异性抗原 GLEASON评分 骨转移 骨扫描 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]