99Tcm-MDP全身骨显像、99Tcm-MDP SPECT-CT和18F-FDG SPECT-CT探测脊柱转移瘤的比较

Comparision of the value of 99Tcm-MDP bone scintigraphy, 99Tcm-MDP SPECT-CT and 18F-FDG SPECT-CT in detecting bone metastases of spine

    摘要
  • 摘要:
    目的 比较99Tcm-亚甲基二膦酸盐（99Tcm-MDP）全身骨显像、99Tcm-MDP SPECT-CT与18F-FDG SPECT-CT诊断脊柱转移瘤的临床价值。
    方法 对行常规99Tcm-MDP全身骨显像的88例肿瘤患者同时行99Tcm-MDP SPECT-CT，同期（2周内）行18F-FDG SPECT-CT。回顾性分析患者临床资料，以病理结果或两种以上影像技术（MRI、CT等）结果或随访2年以上结果为最终结果，比较99Tcm-MDP全身骨显像、99Tcm-MDP SPECT-CT与18F-FDG SPECT-CT的诊断结果。
    结果 经临床随访或病理证实，88例肿瘤患者诊断脊柱转移瘤48例、良性病变19例、未转移21例。99Tcm-MDP全身骨显像诊断脊柱转移瘤的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为89.6%（43/48）、62.5%（25/40）、74.1%（43/58）、83.3%（25/30）及63.4%（68/88），99Tcm-MDP SPECT-CT分别为93.8%（45/48）、92.5%（35/40）、90.0%（45/50）、92.1%（35/38）及81.6%（80/88）；18F-FDG SPECT-CT分别为97.9%（47/48）、97.5%（39/40）、97.9%（48/49）、97.5%（39/40）及87.8%（86/88）。SPECT-CT解决了99Tcm-MDP全身骨显像对阳性病灶精确解剖定位难的问题，明显提高了对骨良性病灶的诊断能力，降低了诊断脊柱转移瘤的假阳性率。18F-FDG SPECT-CT较99Tcm-MDP全身骨显像更具肿瘤特异性，对骨骼良恶性病灶的鉴别具有更强的能力，提高了脊柱转移瘤诊断的特异度（χ2=15.313，P < 0.001）和准确率（χ2=16.831，P < 0.001）。
    结论 99Tcm-MDP SPECT-CT和18F-FDG SPECT-CT对脊柱转移瘤的诊断效能高于99Tcm-MDP全身骨显像，具有较高的临床价值。

     

    Abstract:
    Objective To compare the value of 99Tcm-methylene diphosphonate(99Tcm-MDP)bone scintigraphy, 99Tcm-MDP SPECT-CT and 18F-FDG in detecting bone metastases of spine.
    Methods Retro-spective analysis of 88 tumor patients who underwent 99Tcm-MDP planar bone scintigraphy, then performed 99Tcm-MDP SPECT-CT immediately, and then underwent 18F-FDG SPECT-CT within 2 weeks apart. The diagnostic results were confirmed by biopsy, MRI/CT and clinical follow-up.
    Results Fouty-eight of 88 patients were comfirmed to be spine bone metastases, 19 to be spine benigns, 21 to be non-metastases. The sensitivity, specificity, positivity predicitive value, negative predictive value, and accuracy of 99Tcm-MDP bone scintigraphy were 89.6%(43/48), 62.5%(25/40), 74.1%(43/58), 83.3%(25/30)and 63.4%(68/88). Those of 99Tcm-MDP SPECT-CT were 93.8%(45/48), 92.5%(35/40), 90.0%(45/50), 92.1%(35/38)and 81.6%(80/88). Those of 18F-FDG SPECT-CT were 97.9%(47/48), 97.5%(39/40), 97.9%(48/49), 97.5%(39/40)and 87.8%(86/88). SPECT-CT is resolving the problem in conventional bone scintigraphy on anatomical localization of the positive lesions on bone, and reducing the false positive rate. 18F-FDG SPECT-CT is more specific than 99Tcm-MDP bone scintigraphy to the bone metastases of spine, and increasing the ability to identify bone lesion malignant or benign, and increasing the specificity(χ2=15.313, P < 0.001) and accuracy(χ2=16.831, P < 0.001).
    Conclusion The dia-gnostic accuracy of 99Tcm-MDP SPECT-CT and 18F-FDG SPECT-CT in detecting bone metastases of spine are both better than 99Tcm-MDP BS.They are valuable for detecting bone metastases of spine.

     

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