18F-FDG PET/CT双时相显像在溶骨性病变鉴别诊断中的价值研究

The value of 18F-FDG PET/CT dual-phase imaging in the differential diagnosis of osteolytic lesions

    摘要
  • 摘要:
    目的 探讨18F-FDG PET/CT双时相显像代谢参数在溶骨性转移瘤和多发性骨髓瘤（MM）鉴别诊断中的应用价值。
    方法 回顾性收集赤峰市医院2019年9月至2022年6月经组织病理学检查或临床随访证实的溶骨性转移瘤患者50例其中男性29例、女性21例，年龄（56.8±12.8）岁（范围15~80岁）和MM患者 37例其中男性22例、女性15例，年龄（58.5±8.5）岁（范围37~77岁）。对2组患者分别行18F-FDG PET/CT双时相显像，显像剂注射后50~60 min先进行常规（早期）显像，显像剂注射后110~120 min对代谢较高或较大病灶进行延迟显像。以患者为单位，测量溶骨性转移瘤患者原发灶及代谢最高的溶骨性转移灶的早期及延迟显像的最大标准摄取值（SUVmax）；以病灶为单位，测量溶骨性转移瘤患者代谢较高的前3个溶骨性转移灶的早期及延迟显像的SUVmax；MM患者的测量方法与溶骨性转移瘤患者相同。计算2组患者的滞留指数（RI）。溶骨性转移瘤和MM 2组患者间代谢参数的比较采用Mann-Whitney U检验；病灶全身分布的比较采用卡方检验；采用ROC曲线分析鉴别二者的早期SUVmax的最佳临界值及诊断效能。对溶骨性转移瘤组代谢最高的转移灶与原发灶的早期SUVmax行Spearman相关分析。
    结果 以患者为单位，溶骨性转移瘤组早期SUVmax 10.85（8.60, 14.98）高于MM组4.50（3.15, 6.10）；以病灶为单位，溶骨性转移瘤病灶的早期SUVmax10.10（7.80, 12.80）亦高于MM病灶3.50（2.45, 5.45）；溶骨性转移瘤组RI 0.17（0.07, 0.36）高于MM组−0.01（−0.17, 0.36），差异均有统计学意义（z=−6.470、−11.247、−2.576，P<0.05）。早期SUVmax鉴别溶骨性转移瘤与MM的最佳临界值为6.95，灵敏度为83.2%，特异度为87.2%，曲线下面积为0.926（95%CI：0.893−0.959，P<0.001）。溶骨性转移瘤组转移灶与原发灶早期SUVmax之间呈中度正相关（r=0.66，P<0.001）。病灶全身分布的比较结果显示，MM比溶骨性转移瘤更易累及颅骨、颈椎、胸椎及肩锁骨，二者的差异均有统计学意义（χ2=6.585、6.842、4.262、3.999，P<0.05）。
    结论 18F-FDG PET/CT双时相显像代谢参数在溶骨性转移瘤和MM鉴别诊断上，有较好的应用价值。

     

    Abstract:
    Objective To evaluate the diagnostic value of metabolic parameters derived from dual-phase 18F-FDG PET/CT imaging in differentiating osteolytic metastases from multiple myeloma (MM).
    Methods A retrospective analysis was conducted on 50 patients with osteolytic metastases 29 males, 21 females; age 56.8±12.8 years(range 15–80) and 37 patients with MM 22 males, 15 females; age 58.5±8.5 years (range 37–77) confirmed by histopathology or clinical follow-up at Chifeng Municipal Hospital from September 2019 to June 2022. Dual-phase imaging included conventional (early-phase) PET/CT scans 50–60 min post-injection and delayed-phase scans 110–120 min post-injection for lesions with higher metabolism or larger size. On a per-patient basis, the maximum standardized uptake value (SUVmax) of the primary tumor and the most metabolically active osteolytic metastatic lesion was measured in both early and delayed phases. On a per-lesion basis, the SUVmax of up to three lesions with the highest metabolic activity was assessed in both phases. The same measurement protocol was applied for MM.The retention index (RI) was calculated. Differences in metabolic parameters between the two groups were analyzed using the Mann-Whitney U test, while lesion distribution differences were assessed using the chi-square test. ROC curve analysis determined the optimal early SUVmax cutoff and diagnostic efficacy for distinguishing the two groups. Spearman correlation analyzed early SUVmax between the highest-metastasis and primary lesions in the osteolytic metastasis group.
    Results On a per-patient basis, the early SUVmax of osteolytic metastases 10.85 (8.60, 14.98) was higher than that of MM 4.50 (3.15, 6.10). On a per-lesion basis, osteolytic metastases had a higher early SUVmax 10.10 (7.80, 12.80) than MM lesions 3.50 (2.45, 5.45). The RI of osteolytic metastases 0.17 (0.07, 0.36) was also higher than that of MM −0.01 (−0.17, 0.36), with all differences being statistically significant (z=−6.470、−11.247、−2.576, P<0.05). The optimal early SUVmax cutoff for distinguishing osteolytic metastases from MM was 6.95, with a sensitivity of 83.2%, specificity of 87.2%, and AUC of 0.926 (95% CI: 0.893–0.959) (P<0.001). In the osteolytic metastasis group, SUVmax of metastases and primary lesions showed a moderate positive correlation (*r*=0.66, P<0.001). MM lesions were more frequently distributed in the skull, cervical spine, thoracic spine, and shoulder/clavicle compared to osteolytic metastases (χ2=6.585, 6.842, 4.262, 3.999, P<0.05).
    Conclusions Metabolic parameters from dual-phase 18F-FDG PET/CT offer significant value in the differential diagnosis of osteolytic metastases and MM.

     

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