^(18)F-FDG PET/CT显像对多发性骨髓瘤与原因不明溶骨性转移瘤的鉴别诊断价值  

Differential diagnostic value of^(18)F-FDG PET/CT in multiple myeloma and unknown osteolytic metastasis

作　　者：邓成文 张晓莹 吕中伟[1] 李丹[1] Deng Chengwen;Zhang Xiaoying;Lyu Zhongwei;Li Dan(Department of Nuclear Medicine,Tenth People′s Hospital of Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院核医学科,上海200072

出　　处：《中华核医学与分子影像杂志》2022年第5期269-273,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^(18)F-FDG PET/CT对多发性骨髓瘤(MM)与原因不明溶骨性转移瘤(UOM)的鉴别诊断价值。方法回顾性分析2017年6月至2020年3月间在同济大学附属第十人民医院行^(18)F-FDG PET/CT检查的43例患者[男29例,女14例,年龄(61.5±12.9)岁]资料。所有患者全身多发溶骨性骨质破坏且未发现明显骨外恶性肿瘤,病理诊断MM 20例[男13例、女7例,年龄(61.1±12.2)岁],UOM 23例[男16例、女7例,年龄(61.4±13.9)岁]。将全身骨骼分为颅骨、脊柱、肋骨、骨盆、胸骨、锁骨、肩胛骨、四肢长骨,分析每个骨骼部位^(18)F-FDG PET/CT图像中病灶横截面长径、有无骨皮质破坏、SUV_(max)以及显像剂分布是否均匀。采用两独立样本t检验和Mann-Whitney U检验分析数据。结果UOM组患者在锁骨部位未见明显病灶;其余7个骨骼部位中,MM和UOM组患者均以脊柱、骨盆为最好发部位[41.30%(299/724)和49.37%(117/237)、24.45%(177/724)和26.58%(63/237)]。MM组颅骨、脊柱、肋骨、骨盆、四肢长骨部位病灶长径均明显小于UOM组[分别为5.45(4.30,8.06)与(13.89±11.66)mm、6.15(3.89,10.06)与11.48(7.73,16.90)mm、7.01(4.59,10.56)与(24.61±16.22)mm、8.20(5.14,13.71)与(21.12±13.31)mm、(8.48±5.75)与(19.13±14.26)mm;z值:-8.88~-2.52,t=-2.76,P<0.001或P<0.05];MM组上述部位及肩胛骨病灶SUV_(max)也明显小于UOM组[分别为1.50(1.00,2.20)与17.15±11.40、2.60(2.00,4.10)与8.20(5.65,11.90)、2.30(1.40,5.28)与10.58±5.52、2.50(1.80,3.90)与9.34±6.01、3.08±2.41与11.38±6.38、2.45(1.50,4.43)与6.90(4.63,17.80);z值:-13.87~-2.41,t=-4.85,P<0.001或P<0.05]。在颅骨、脊柱、肋骨、骨盆、肩胛骨、四肢长骨部位的病灶,MM组以显像剂弥漫性分布多见,而UOM组则以不均匀分布多见;在颅骨、脊柱、肋骨部位的病灶,MM组表现为无骨皮质破坏,而UOM组则表现为骨皮质破坏。结论综合比较^(18)F-FDG PET/CT图像中病灶骨皮质破坏情况、SUV_(max)、病灶长径、显像剂分布,可�Objective To investigate the differential diagnostic value of^(18)F-FDG PET/CT in multiple myeloma(MM)and unknown osteolytic metastasis(UOM).Methods A retrospective study was performed on^(18)F-FDG PET/CT imaging of 43 patients(29 males,14 females,age:(61.5±12.9)years)with multiple bone destructions and without extraosseous primary malignant tumor between June 2017 and March 2020 in Tenth People′s Hospital of Tongji University.Through follow-up,20 patients(13 males,7 females,age:(61.1±12.2)years)were pathologically confirmed as MM and 23 patients(16 males,7 females,age:(61.4±13.9)years)were pathologically confirmed as UOM.The whole body skeleton was categorized to 8 sites including skull,spine,ribs,pelvis,sternum,clavicle,scapula and limb bone.The differences of the cross-sectional length of the lesion,cortical bone damage,SUV_(max)and the distribution of imaging agent were compared between the two groups in different parts.Independent-sample t test and Mann-Whitney U test were used to analyze data.Results The UOM group was invisible on clavicles,and spine and pelvis were the most predilection sites in both MM and UOM groups(spine:41.30%(299/724)and 49.37%(117/237);pelvis:24.45%(177/724)and 26.58%(63/237)).The cross-sectional length of lesions in the skull,spine,ribs,pelvis and limb bone in MM group were significantly shorter than those in UOM group(5.45(4.30,8.06)vs(13.89±11.66)mm,6.15(3.89,10.06)vs 11.48(7.73,16.90)mm,7.01(4.59,10.56)vs(24.61±16.22)mm,8.20(5.14,13.71)vs(21.12±13.31)mm,(8.48±5.75)vs(19.13±14.26)mm;z values:from-8.88 to-2.52,t=-2.76,P<0.001 or P<0.05)and SUV_(max)of above lesions and scapula in MM group were significantly lower than those in UOM group(1.50(1.00,2.20)vs 17.15±11.40,2.60(2.00,4.10)vs 8.20(5.65,11.90),2.30(1.40,5.28)vs 10.58±5.52,2.50(1.80,3.90)vs 9.34±6.01,3.08±2.41 vs 11.38±6.38,2.45(1.50,4.43)vs 6.90(4.63,17.80);z values:from-13.87 to-2.41,t=-4.85,P<0.001 or P<0.05).The imaging agents in lesions on the skull,spine,ribs,pelvis,scapula and limb bone were more evenly

关 键 词：多发性骨髓瘤 肿瘤转移 骨骼 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

分 类 号：R733.3[医药卫生—肿瘤] R730.44[医药卫生—临床医学]