PET/CT显像与全身骨扫描诊断转移性骨肿瘤的比较研究

目的:评价正电子发射计算机断层扫描(positron emission tomography/computed tomography,PET/CT)18F标记的氟脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)全身显像与99mTc标记的亚甲基二磷酸盐(99mTc-methylene diphosphonate,99mTc-MDP)全身骨扫描(bone scintigraphy,BS)诊断转移性骨肿瘤的效能。方法:共计75例临床确诊的恶性肿瘤患者纳入本研究,平均年龄(59.85±13.50)岁。所有患者在2周内接受18F-FDG PET/CT显像和99mTc-MDP BS,以病例为单位,分别计算PET/CT显像与全身BS诊断骨转移的敏感度、特异度、阳性预测值(positive predictive value,PPV)、阴性预测值(negative predictive value,NPV)和准确度,并分析两者在全身不同区域的显像特点。结果:75例患者最终诊断为有骨转移者34例,无骨转移者41例。PET/CT显像诊断骨转移的敏感度和特异度分别为94.1%(32/34)和95.1%(39/41),诊断的PPV、NPV和准确性分别为94.1%、95.1%和94.7%。BS诊断的敏感度和特异度分别为91.2%(31/34)和65.9%(27/41),PPV、NPV和准确性分别为68.9%、90.0%和77.3%。PET/CT显像发现病灶数量较多的部位依次为脊柱、肋骨和骨盆,BS发现病灶数量较多的部位依次为肋骨、脊柱和四肢。结论:18F-FDG PET/CT显像诊断骨转移的特异性、准确性和PPV均明显高于BS,但两者在诊断敏感度和NPV方面并无明显差异。

Diagnosis and evaluation of bone metastasis with PET/CT and bone scintigraphy in patients with malignancies

Objective:To evaluate diagnostic value of PET/CT with 18F-FDG and whole-body bone scintigraphy (BS)with 99mTc-MDP for metastatic bone tumor in patients with malignancies. Methods:A total of 75 patients with malignances,average of 59.85 ± 13.59 years old,were included in this study. All patients underwent PET/CT imaging with 18F-FDG and BS with 99mTc-MDP for two weeks. Based on the diagnostic results of patients,we calculated the sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV),and accuracy of PET/CT imaging and BS method to detect bone metastasis. Moreover,image features on different body regions were assessed and compared between two imaging methods. Results:There were 34 patients diagnosed with skeletal metastasis among all 75 patients. The sensitivity of PET/CT was 94.1%(32/34) in detecting bone metastasis. The specificity of PET/CT was 95.1%(39/41)The PPV,NPV and accuracy of PET/CT were 94.1%,95.1% and 94.7%,respectively. For BS with 99mTc-MDP,the sensitivity of detecting skeletal metastasis was 91.2%(31/34)and the specificity was 65.9%(27/41). The PPV,NPV and accuracy of BS were 68.9 %,90 % and 77.3 %,respectively. On basis of region analysis,the main abnormal uptakes of 18F-FDG were located in spine,rib and pelvis by PET/CT detection. For BS with 99mTc-MDP,the main lesions were located in rib,spine and bones of limbs. Conclusion:The specificity,accuracy and PPV of PET/CT imaging were higher than those of BS. However,there was no significant difference in sensitivity and NPV between PET/CT imaging and BS.