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目的对比分析下肢长骨骨肉瘤的PET/CT及CT影像,探讨PET/CT和CT对骨肉瘤远近转移灶的检出情况和两种检查对临床分期的诊断价值。方法收集入组经穿刺活检证实的下肢长骨骨肉瘤患者14例,均行术前全身平扫CT和PET/CT检查,并对肿瘤影像特点、髓腔及肺转移灶影像进行分析。结果原发病灶的平均最大标准化摄取值(SUVmax)是10.68(3.7～21.1),PET/CT发现有转移组患者SUVmax平均值高于无转移组患者(11.94vs 8.01,P<0.05)。PET/CT发现髓腔转移6例8处,相应的CT检查只发现2例2处;PET/CT发现肺转移3例,而相应的CT检查发现肺转移2例。PET/CT对骨髓腔内转移灶的敏感性高于CT检查(P=0.088 67<0.1),而对于肺转移灶的检出率二者差异无统计学意义。PET/CT与CT影像相比,使4例患者的TNM分期有所增加,二者差异有统计学意义(P<0.05)。结论相比于CT检查,PET/CT可以更好地显示骨肉瘤肿瘤范围,对肿瘤的分期诊断较为准确,易于检出髓腔内转移灶,SUVmax值可能有利于评判患者预后。
Objective To compare the PET / CT and CT images of long bone osteosarcoma of the lower extremities to explore the detection of distant metastasis of osteosarcoma by PET / CT and CT, and to evaluate the diagnostic value of the two methods in clinical staging. Methods Fourteen patients with osteosarcoma of the lower extremities confirmed by biopsy were enrolled in the study. All patients underwent preoperative CT and PET / CT examinations. The imaging features of the tumor, the medullary cavity and the lung metastases were analyzed. Results The average maximum normalized value (SUVmax) of primary lesion was 10.68 (3.7-21.1). The average SUVmax of patients with metastasis was higher than those without metastasis (11.94 vs 8.01, P <0.05) by PET / CT. PET / CT found that there were 6 cases of medullary cavity metastasis in 8 cases. Corresponding CT examination only found 2 cases in 2 cases. PET / CT found 3 cases of lung metastasis, and 2 cases of lung metastasis by CT examination. The sensitivity of PET / CT in metastatic bone marrow cavity was higher than that of CT (P = 0.08867 <0.1), but no significant difference was found in the detection rate of lung metastases between PET / CT. Compared with CT images, PET / CT increased the TNM staging of 4 patients (P <0.05). Conclusion Compared with CT, PET / CT can better display the scope of tumor of osteosarcoma. It is more accurate to diagnose the tumor staging and easy to detect the metastasis in medullary cavity. SUVmax value may be helpful to evaluate the prognosis of patients.