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骨骼肿瘤在人群中的发病率较低,仅约为0.01%,其中良性骨肿瘤占50%,恶性骨肿瘤占40%,骨肿瘤样病变占10%。肿瘤以及肿瘤样病变均可有FDG摄取[1-2],笔者在日常诊断工作中发现,对于骨骼孤立性FDG摄取增高病灶,如何定性是一个难题,因此本文就本中心收集的经病理证实的22例骨骼孤立性高代谢病灶进行回顾性分析,旨在提高诊断的准确率。
18F-FDGPET/CT对骨骼孤立性高代谢病灶的初步诊断价值
Preliminary study of 18F-FDG PET/CT in the diagnosis of solitary hypermetabolic lesion of bone
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摘要:
目的 分析骨骼孤立性高代谢病灶的18F-FDG PET/CT表现,以提高其诊断的水平。 方法 回顾性分析22例经病理学确诊的骨骼孤立性高代谢病灶的PET/CT征象。 结果 22例患者中,淋巴瘤及嗜酸性肉芽肿各5例、浆细胞性骨髓瘤及骨肉瘤各4例、尤文氏肉瘤和Ⅰ级骨巨细胞瘤各2例。病灶平均SUVmax为11.08±8.06(2.1~32.6)。良恶性病灶对FDG摄取的差异无统计学意义(SUVmax:8.86±2.40vs. 12.12±9.58,t=-1.241,P=0.231)。按病理类型进行分类,不同病理类型骨骼病灶对FDG摄取的差异无统计学意义(F=0.296,df=5,P=0.908)。浆细胞骨髓瘤及骨巨细胞瘤易出现FDG摄取不均。同机CT主要表现:溶骨性破坏17例,伴硬化边5例,形成“领结征”、“皂泡征”、“花边征”等典型征象;成骨性改变5例,见于淋巴瘤及骨肉瘤;软组织肿块形成17例;骨膜反应4例。 结论 PET难以对骨骼孤立性病灶进行定性,密切结合同机CT征象有助于诊断。 -
关键词:
- 骨肿瘤 /
- 诊断,鉴别 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 氟脱氧葡萄糖F18 /
- 孤立性高代谢病灶
Abstract:objective This study aims to investigate the clinical value of 18F-FDG PET/CT in diagnosing solitary hypermetabolic lesion of the bone. Methods Twenty-two patients with solitary FDG uptake in the bone were enrolled. Patient diagnosis was confirmed by biopsy or surgery. PET/CT images were analyzed. Results Of the 22 patients, 5 had primary bone lymphoma and bone eosinophilic granuloma, 4 had plasma cell myeloma and osteosarcoma, and 2 had Ewing's sarcoma and giant cell tumor of the bone. The mean SUVmax of bone lesions is 11.08±06(2.1-32.6). Nineteen lesions had well-distributed FDG uptake. The other three lesions were unevenly distributed. No significant difference in FDG uptake was found between malignant and benign lesions(SUVmax:8.86±40 vs. 12.12±58, respectively; t=-1.241, P=0.231), and among different kinds of bone lesions(F=0.296, df=5, P=0.908). Syn-modality CT images showed that 17 patients have osteolytic changes, 5 of which with sclerosis edge. Some bone lesions presented as "bow tie sign", "oap bubble sign? and lace sign? The other 5 patients, 3 with primary bone lymphoma and 2 with osteosarcoma, presented with ossification changes. Otherwise, soft tissue mass was formulated in 17 patients, and periosteal proliferation developed in 4 patients. Conclusion Syn-modality CT images should be included in the differential diagnosis of solitary hypermetabolic lesion of the bone. -
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