多模态显像在嗜铬细胞瘤/副神经节瘤骨转移诊断中的对比研究  

Comparison of multimodal imaging for diagnosis of bone metastases in patients with pheochromocytoma and paraganglioma

作　　者：李隆敏 高洪波 李赟 金从军 谢慧梁 赵春元 李征 李娜 刘海春 张晓勇 邵玉军 LI Longmin;GAO Hongbo;LI Yun;JIN Congjun;XIE Huiliang;ZHAO Chunyuan;LI Zheng;LI Na;LIU Haichun;ZHANG Xiaoyong;SHAO Yujun(Department of Radionuclide Treatment Center,Beijing Nuclear Industry Hospital,Beijing 102413,China;Cancer Center of Suining Central Hospital,Sichuan Suining 629000,China)

机构地区：[1]北京核工业医院核素诊疗中心,北京102413 [2]遂宁市中心医院肿瘤中心,四川遂宁629000

出　　处：《现代肿瘤医学》2022年第21期3967-3973,共7页Journal of Modern Oncology

基　　金：北京核工业医院院长基金(编号:YZJJ-2018-005)。

摘　　要：目的:对比研究^(131)I-MIBG显像、^(18)F-FDG PET/CT显像与^(99)Tc^(m)-MDP-WBS多模态显像在嗜铬细胞瘤/副神经节瘤(PCC/PGL)骨转移病灶中的诊断价值。方法:回顾性分析本院收治的PCC/PGL患者共30例,所有患者均伴骨转移且已行以上三种检查(检查的时间间隔为3个月内)。以病理、影像学检查及临床随访结果作为骨转移的诊断依据。比较三种检查方法检测PCC/PGL骨转移病灶的灵敏度、特异性、阳性及阴性预测值和准确性。使用SPSS 25.0软件分析,采用McNemar检验比较三种检查方法诊断骨转移的价值。结果:30例PCC/PGL患者共检查出骨异常病灶302处,确诊为骨转移病灶271处。^(131)I-MIBG显像、^(18)F-FDG PET/CT显像与^(99)Tc^(m)-MDP-WBS在诊断PCC/PGL骨转移病灶时的灵敏度、特异性、阳性和阴性预测值及准确性分别是92.00%、96.30%、99.60%、54.17%、92.38%;96.00%、92.59%、99.25%、69.44%、95.70%和88.39%、62.86%、94.78%、41.51%、85.43%。三种检查方法在诊断PCC/PGL骨转移病灶时^(18)F-FDG PET/CT显像灵敏度最高,^(131)I-MIBG显像特异性最好。三种检查方法的诊断效能经McNemar检验,差异有统计学意义(P<0.05)。结论:^(131)I-MIBG显像可作为PCC/PGL骨转移的首选检查方法并指导后续^(131)I-MIBG治疗,^(18)F-FDG PET/CT显像和^(99)Tc^(m)-MDP-WBS可作为可疑病灶^(131)I-MIBG显像阴性时的有效补充。Objective:To compare the diagnostic ability of ^(131)I-MIBG scan,^(18)F-FDG PET/CT scan and ^(99)Tc^(m)-MDP-WBS for the detection of bone metastases from pheochromocytoma(PCC)and paraganglioma(PGL).Methods:Thirty patients of PCC/PGL with bone metastases were retrospectively analysed.All patients were examined with ^(131)I-MIBG scan,^(18)F-FDG PET/CT scan and ^(99)Tc^(m)-MDP-WBS with a maximum interval of three months.Bone metastases were verified either by tumor pathologies or imaging methods or follow-up more than six months.The McNemar's test was used to compare the diagnostic ability of the three inspection methods.All analyses were performed with SPSS 25.0 and P value<0.05 was considered statistically significant difference.Results:A total of 302 abnormal lesions were detected in the 30 patients with PCC/PGL,with 271 lesions were diagnosed as being true positive.In patient-based analysis,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of ^(131)I-MIBG scan were 92.00%,96.30%,99.60%,54.17% and 92.38%,respectively.Those of ^(18)F-FDG PET/CT were 96.00%,92.59%,99.25%,69.44% and 95.70%,and those of ^(99)Tc^(m)-MDP-WBS were 88.39%,62.86%,94.78%,41.51%and 85.43%,respectively.The sensitivity of ^(18)F-FDG PET/CT was the highest and ^(131)I-MIBG has the best specificity,while ^(99)Tc^(m)-MDP-WBS has poor sensitivity and specificity in the diagnosis of bone metastasis of PCC/PGL.Comparing the diagnostic ability using the McNemar test,the three modalities were significantly different(P<0.05).Conclusion:^(131)I-MIBG scan remains to be the first choice in detecting PPGL with bone metastasis to guide the follow-up ^(131)I-MIBG treatment.However,a negative finding of ^(131)I-MIBG scan cannot rule out the diagnosis of bone metastasis,then ^(18)F-FDG PET/CT,^(99)Tc^(m)-MDP-WBS can be performed.

关 键 词：嗜铬细胞瘤 副神经节瘤 骨转移 单光子发射型计算机断层成像 正电子发射型计算机断层成像 ^(131)I-间碘苄胍 ^(18)F-氟脱氧葡萄糖 ^(99)Tc^(m)-亚甲基二膦酸盐 

分 类 号：R733.3[医药卫生—肿瘤]