^(18)F-FDG PET/CT在硬脊膜内转移诊断中的应用  

Diagnostic Application of ^(18)F-FDG PET/CT in Intradural Metastasis

作　　者：金爱芳[1] 骆柘璜[1] JIN Aifang;LUO Zhehuang(Department of PET/CT Center of Nuclear Medicine,Jiangxi Provincial People′s Hospital(the First Affiliated Hospital of Nanchang Medical College),Nanchang 330006,China)

机构地区：[1]江西省人民医院(南昌医学院第一附属医院)核医学科PET/CT中心,江西南昌330006

出　　处：《中国医学影像学杂志》2024年第2期125-129,共5页Chinese Journal of Medical Imaging

摘　　要：目的评价^(18)F-FDG PET/CT在硬脊膜内转移诊断中的价值。资料与方法回顾性分析2010年10月—2022年4月于江西省人民医院行^(18)F-FDG PET/CT和MRI检查且确诊椎管内转移肿瘤患者的影像资料,对病灶代谢活性进行视觉分析,并测量最大标准化摄取值(SUVmax)。分析^(18)F-FDGPET/CT诊断硬脊膜内转移的敏感度、特异度和准确度,并应用受试者工作特征曲线分析SUVmax诊断硬脊膜内转移的效能。结果135例伴可疑椎管内转移症状的肿瘤患者中,硬脊膜内(软脊膜和髓内)转移18例,其他病变80例,脊髓无病变37例。18例硬脊膜内转移中,13例软脊膜转移,2例髓内转移,3例同时有软脊膜和髓内转移。转移表现为结节状(10例)或条片状(6例)18F-FDG摄取增高,对应CT上髓旁或髓内结节或脊髓肿胀。^(18)F-FDGPET/CT比MRI发现了更多的病灶,包括亚厘米的病灶。基于患者,^(18)F-FDGPET/CT诊断硬脊膜内转移的敏感度、特异度和准确度分别为88.9%、89.2%、89.1%;以转移灶和正常脊髓SUVmax进行受试者工作特征曲线分析显示,界值为2.45时约登指数最大,对应敏感度、特异度分别为88.2%、75.7%。结论18F-FDG PET/CT是诊断硬脊膜内转移的一种可选择影像模式。硬脊膜内转移大多数表现为局灶性高代谢病变,SUVmax可作为诊断硬脊膜内转移的一个有价值的参考指标。Purpose To evaluate the value of ^(18)F-FDG PET/CT in the diagnosis of intradural metastasis.Materials and Methods The imaging data of patients with clinical suspicion of intraspinal metastasis who underwent ^(18)F-FDG PET/CT and MRI of the whole spinal cord from October 2010 to April 2022 in Jiangxi Provincial People′s Hospital were retrospectively analyzed.Visual evaluation was performed on the metabolic activity of the lesion and the maximum standard uptake value(SUVmax)was measured.The sensitivity,specificity and accuracy of ^(18)F-FDG PET/CT in the diagnosis of intradural metastases were analyzed,and the efficacy of SUVmax in the diagnosis of intradural metastases was analyzed by receiver operating characteristic curve.Results Among 135 patients suspected of intraspinal metastasis,18 patients were diagnosed with intradural metastases,80 patients had other lesions and 37 patients had no metastasis.Among the 18 cases of intradural metastases,13 cases were leptomeningeal metastases,2 cases were intramedullary metastasis,3 patients had both leptomeningeal and intramedullary metastasis.Metastases appear as nodular(10 cases)or patchy(6 cases)increased fluorodeoxyglucose uptake,corresponding to paramedullary or intramedullary nodules or spinal cord swelling on CT.^(18)F-FDG PET/CT showed more lesions than MRI,including subcentimeter foci.Based on patients,the sensitivity,specificity and accuracy of ^(18)F-FDG PET/CT in diagnosing intradural metastasis were 88.9%,89.2%and 89.1%,respectively.The receiver operating characteristic curve analysis showed that when SUVmax was 2.45,Youden index was the largest,corresponding to 88.2%sensitivity and 75.7%specificity.Conclusion ^(18)F-FDG PET/CT may be an optional imaging modality for diagnosis of intradural metastases.Most of the intradural metastases present with focal hypermetabolic lesions.SUVmax can be used as a valuable parameter in the diagnosis of intradural metastases.

关 键 词：硬脊膜内转移 软脊膜转移 脊髓内转移 正电子发射断层显像术 体层摄影术 X线计算机 氟代脱氧葡萄糖 

分 类 号：R739.45[医药卫生—肿瘤] R739.42[医药卫生—临床医学] R739.41R445.3