-
乳腺癌发病率已占女性恶性肿瘤发病的第一位,而且呈上升趋势[1-2]。骨是乳腺癌最常见的远处转移部位,骨转移约占所有乳腺癌患者的70%[2]。99Tcm-MDP全身骨显像是目前探查乳腺癌骨转移最常用且有效的方法,其灵敏度高,但特异度相对较差,往往需要结合其他影像学检查方能做出判断。近年随着SPECT/CT的逐渐普及,其在临床肿瘤学中的应用日益广泛且重要[3]。本研究旨在评价99Tcm-MDP SPECT/CT同机融合显像对乳腺癌患者骨转移的诊断价值。
-
132例患者共210个病灶,病灶位于脊椎97个(46.2%)(典型病例见图 1~图 2)、肋骨43个(20.5%)、胸骨32个(15.2%)、骨盆21个(10.0%)、四肢及颅骨17个(8.1%)。
图 1 乳腺癌患者脊柱良性病变的99Tcm-MDP全身骨显像和SPECT/CT显像图。患者女性,70岁,乳腺癌术后5年,99Tcm-MDP全身骨显像示第4颈椎左侧缘浓集灶(1a);SPECT/CT融合显像示第4颈椎左侧横突退变、增生伴放射性浓集(1b),诊断为良性病变;随访4年后见中段颈椎浓集灶减轻(1c)。
Figure 1. Images of spine benign lesions by whole body bone scan and SPECT/CT fusion imaging
图 2 乳腺癌患者脊柱转移性病变的99Tcm-MDP全身骨显像、SPECT/CT融合显像及PET/CT显像图。患者女性,48岁,乳腺癌术后1年,99Tcm-MDP全身骨显像示第2~3颈椎浓集灶(2a);SPECT/CT融合显像示第2~3颈椎溶骨性骨质破坏伴放射性浓集(2b),诊断为肿瘤骨转移;6个月后18F-FDG PET/CT显像亦示第2~3颈椎溶骨性骨质破坏伴代谢增高(2c)。
Figure 2. Images of the spine metastatic lesions by 99Tcm-whole body bone scan, SPECT/CT fusion imaging and PET/CT imaging
依据随访标准通过高性能专用诊断CT、MRI检查明确病灶87个,以手术或穿刺病理明确病灶23个,通过全身骨显像或SPECT/CT融合显像复查明确病灶88个,通过PET/CT明确病灶12个。所有患者随访确诊时间为SPECT/CT显像后1~12个月,平均5.4个月。最终临床诊断为乳腺癌骨转移病灶87个(41.4%),良性病灶123个(58.6%)。SPECT/ CT正确诊断恶性病灶82个,良性病灶112个,诊断准确率92.4%,对乳腺癌骨转移病灶的诊断灵敏度为94.3%,特异度为91.1%,阳性预测值为88.2%,阴性预测值为95.7%(表 1)。
SPECT/CT诊断 最终临床诊断 合计 恶性 良性 恶性 82 11 93 良性 5 112 117 合计 87 123 210 表 1 SPECT/CT融合显像对乳腺癌骨转移灶的诊断结果
Table 1. Results of SPECT/CT fusion imaging in diagnosing metastatic bone lesions in breast cancer
(个) -
SPECT/CT融合显像对不同部位病灶的诊断准确率不一致,按照诊断准确率由高至低排列,依次为脊椎、骨盆、胸骨、四肢及颅骨、肋骨。对脊椎与肋骨部位病灶的诊断准确率进行比较,其差异有统计学意义(χ2=7.81,P<0.05)(表 2)。
病灶部位 病灶总数 病灶诊断准确数 准确率(%) 恶性 良性 脊椎 97 31 62 95.9 肋骨 43 12 24 83.7 胸骨 32 13 17 93.8 骨盆 21 16 4 95.2 四肢及颅骨 17 10 5 88.2 表 2 SPECT/CT融合显像对不同部位病灶的诊断结果
Table 2. Results of SPECT/CT fusion imaging in diagnosing metastatic bone lesions in different parts of body
SPECT/CT融合显像对乳腺癌骨转移的诊断价值
Clinical value of SPECT/CT fusion imaging in diagnosing metastatic bone lesions in breast cancer
-
摘要:
目的 评价SPECT/CT融合显像对99Tcm-MDP全身骨显像难于确诊的乳腺癌骨病灶的鉴别诊断价值。 方法 对99Tcm-MDP全身骨显像难于确诊的132例乳腺癌患者的210个病灶行局部SPECT/CT同机融合断层显像,以临床随访及病理检查获得最终诊断结果,计算SPECT/CT融合显像对骨转移灶的诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值,并对比不同部位病灶的诊断准确率差异。 结果 ① 210个病灶经SPECT/CT融合断层显像正确诊断的恶性病灶82个(39.0%),良性病灶112个(53.3%),诊断准确率为92.4%(194/210),灵敏度为94.3%,特异度为91.1%,阳性预测值为88.2%,阴性预测值为95.7%。②SPECT/CT同机融合断层显像对不同部位的病灶的诊断准确率不一致,脊椎的诊断准确率最高,为95.9%(94/97),肋骨最低,为83.7%(36/43),其差异有统计学意义(χ2=7.81,P<0.05)。 结论 SPECT/CT同机融合显像能够对99Tcm-MDP全身骨显像难于确诊的病灶进行准确诊断,其对不同部位的病灶的诊断准确率有差异,脊椎的诊断准确率最高,肋骨最低。 -
关键词:
- 乳腺肿瘤 /
- 肿瘤转移 /
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机
Abstract:Objective To evaluate the diagnostic value of SPECT/CT fusion imaging in indeterminate lesions on 99Tcm-MDP whole-body bone scan in patients with breast cancer. Methods 210 bone lesions of 132 patients with breast cancer, for whom the natures of the lesions were unable to be determined by the 99xTcm-MDP whole-body bone scan, were examined by the SPECT/CT fusion imaging simultaneously. The natures of the lesions were eventually confirmed by pathology and clinical follow-up. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of SPECT/CT fusion imaging for diagnosing bone-metastases were calculated. In addition, the diagnostic accuracy of SPECT/CT fusion imaging for bone lesions in various parts of the body was also analyzed. Results ① Of 210 bone lesions, 82 of bone metastases and 112 benign bone lesions were correctly diagnosed by SPECT/CT fusion imaging. The diagnostic accuracy, sensitivity, specificity, positive prediction value and negative prediction value was 92.4%(194/210), 94.3%(82/87), 91.1%(112/123), 88.2%(82/93), 95.7%(112/117), respectively. ②The diagnostic accuracy of 99Tcm-MDP SPECT/CT for spinal bone lesions were significantly higher than that for rib lesions(95.9% versus 83.7%, χ2=7.81, P < 0.05). Conclusions ① 92.4% bone lesions in patients with breast cancer, which can not determined on 99Tcm-MDP whole-body bone scan, can be diagnosed by SPECT/CT fusion imaging accurately. ②Diagnositic compliance rate of SPECT/CT fusion imaging is different in different parts with obscure lesion, which is the highest in the spine, the minimum in ribs. -
图 2 乳腺癌患者脊柱转移性病变的99Tcm-MDP全身骨显像、SPECT/CT融合显像及PET/CT显像图。患者女性,48岁,乳腺癌术后1年,99Tcm-MDP全身骨显像示第2~3颈椎浓集灶(2a);SPECT/CT融合显像示第2~3颈椎溶骨性骨质破坏伴放射性浓集(2b),诊断为肿瘤骨转移;6个月后18F-FDG PET/CT显像亦示第2~3颈椎溶骨性骨质破坏伴代谢增高(2c)。
Figure 2. Images of the spine metastatic lesions by 99Tcm-whole body bone scan, SPECT/CT fusion imaging and PET/CT imaging
表 1 SPECT/CT融合显像对乳腺癌骨转移灶的诊断结果
Table 1. Results of SPECT/CT fusion imaging in diagnosing metastatic bone lesions in breast cancer
(个) SPECT/CT诊断 最终临床诊断 合计 恶性 良性 恶性 82 11 93 良性 5 112 117 合计 87 123 210 表 2 SPECT/CT融合显像对不同部位病灶的诊断结果
Table 2. Results of SPECT/CT fusion imaging in diagnosing metastatic bone lesions in different parts of body
病灶部位 病灶总数 病灶诊断准确数 准确率(%) 恶性 良性 脊椎 97 31 62 95.9 肋骨 43 12 24 83.7 胸骨 32 13 17 93.8 骨盆 21 16 4 95.2 四肢及颅骨 17 10 5 88.2 -
[1] 李霓, 郑荣寿, 张思维, 等.中国城乡女性乳腺癌发病趋势分析和预测[J].中华预防医学杂志, 2012, 46(8): 703-707.
[2] Kozlow W, Guise TA. Breast cancer metastasis to bone: mechanisms of osteolysis and implications for therapy[J]. J Mammary Gland Biol Neoplasia, 2005, 10(2): 169-180. [3] 孟德刚, 孙晓光, 黄钢. SPECT/CT在临床肿瘤学中的应用[J].国际放射医学核医学杂志, 2009, 33(4): 214-218.
[4] Utsunomiya D, Shiraishi S, Imuta M, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT[J]. J Radiology, 2006, 238(1): 264-271. [5] 江勇, 米岚, 余大富, 等. SPECT/CT对脊柱病变鉴别诊断的价值[J].中华核医学杂志, 2011, 31(4): 223-226.
[6] 孟德刚, 孙晓光, 黄刚, 等. SPECT/CT骨显像在多发性骨髓瘤诊断中的临床应用[J].医学影像杂志, 2010, 20(4): 559-562.
[7] 马玉波, 王忠, 顾爱春, 等. SPECT/CT图像融合鉴别诊断疑似骨转移灶良恶性的价值[J].上海交通大学学报, 2010, 30(10): 1246-1250.
[8] Rèmer W, Nèmayr A, Uder M, et al. SPECT-guided CT for evaluating foci of increased bone metabolish classifield as indeterminate on SPECT in cancer patients[J]. J Nucl Med, 2006, 47(7): 1102-1106. [9] Sharma P, Singh H, Kumar R, et al. Bone scintigrsphy in breast cancer: added value of hybrid SPECT-CT and its impact on patient management[J]. Nucl Med Commun, 2012, 33(2): 139-147. [10] 顾涛颖, 石洪成, 陈曙光, 等. SPECT-CT融合图像评价乳腺癌骨转移的增益价值[J].中国临床医学, 2013, 20(5): 665-669.
[11] 张一秋, 石洪成, 陈曙光, 等. SPECT/CT融合图像对脊柱单发病灶鉴别诊断的增益价值[J].中国临床医学, 2010, 17(5): 741-744.
[12] Schillaci O. Hybrid SPECT/CT: a new era for SPECT imaging?[J]. Eur J Nucl Med Mol Imaging, 2005, 32(5): 521-524.