论文部分内容阅读
目的探讨SPECT/CT骨显像在肿瘤骨转移诊断中的增益价值.方法对78例可疑肿瘤骨转移的患者行99mTc-MDP SPECT全身骨显像,对发现的阳性病灶行SPECT/CT融合显像.回顾性分析患者资料,全身骨显像和SPECT/CT融合显像结果与病理结果对照8例,与其他影像学(CT、MRI、X线)诊断结果对照42例,与随访1年结果对照28例,计算全身骨显像和SPECT/CT融合显像与这些对照方法的诊断符合率,并对两者诊断符合率行χ2检验.结果78例患者全身骨显像骨骼系统可见169处异常放射性浓聚灶,经过SPECT/CT融合显像发现:其中1处为放射性污染造成的假阳性病灶,23处为骨质增生性病变,10处系外伤、手术所致,135处为骨转移肿瘤导致的成骨性病灶或骨质破坏.全身骨显像诊断与对照方法诊断比较,全身骨显像肯定性诊断总符合率81.8%(45/55),其中良性病变的诊断符合率为88.0%(22/25),骨转移的诊断符合率为76.7%(23/30).SPECT/CT融合显像肯定性诊断的总符合率为97.1%(68/70),其中良性病变的诊断符合率为100.0%(32/32),骨转移的诊断符合率为94.7%(36/38);肯定性的诊断符合率SPECT/CT融合显像明显高于全身骨显像,两者比较有统计学意义(χ2=8.335,P<0.01);肯定性肿瘤骨转移的诊断符合率SPECT/CT融合显像明显优于全身骨显像,两者比较有统计学意义(χ2=4.767,P<0.05).结论 SPECT/CT骨显像在肿瘤骨转移诊断中较全身骨显像有增益价值,可以提供更多的诊断信息.“,”Objective To evaluate the added diagnostic value of SPECT/CT imaging over routine planar whole body bone scintigraphy (WBBS) for bone metastases from malignant tumors. Methods Seventy eight cases with malignant tumors,who suspected for bone metastasis,underwent routine 99mTc-methylene diphosphonic acid(MDP) (740-1110MBq) WBBS, folowed by SPECT/CT imaging over the regions with indeterminate findings on WBBS. Both WBBS and bone SPECT/CT images were interpreted by two experienced nuclear medicine physicians in consensus as the positive,negative or uncertain bone metastases. The final diagnosis was comfirmed by pathology or clinical folow-up. Diagnosis was confirmed by pathology(n=8),more than two kinds of radiological imaging(MRI,CT,X-ray)(n=42) and clinical folow-up in one years(n=28). χ2-test was used to compare the differences between the two imaging methods. Results The foci of increased activity were 169 in 78 cases analyzed by WBBS. However,one of total 169 analyzed by SPECT/CT related to the contamination of 99mTc-MDP,23 related to the hyperosteogeny,10 related to the operation or external injury and 135 related to the bone lesions of the bone metastases. In 78 patients,WBBS of 55 cases matched the final diagnosis in which 22 had benign lesions and 23 had bone metastases,The definite coincidence rates were 81.8%(45/55);bone SPECT/CT images of 70 cases matched the final diagnosis in which 32 had benign lesions and 36 cases diagnosed as bone metastases,The definite coincidence rates were 97.1%(68/70). Difference in the definte coincidence rates of bone metastases between WBBS and bone SPECT/CT was statisticaly significant(χ2=4.767 , P<0.05). Conclusion bone SPECT/CT imaging provides incremental diagnostic value over routine WBBS for bone metastases from malignant tumors.