99Tcm-MDP骨显像肺部病变的定量分析

目的 99 Tcm亚甲基二膦酸盐(99 Tcm-Methylenediphosphonate,99Tcm-MDP)骨显像为肿瘤患者常规检查项目.骨外组织包括肺部各种病变,可不同程度的摄取显像剂.本研究对肺部不同病变异常放射性摄取进行定量分析和精确诊断.方法 收集2012-01-01-2015-05-01山东大学附属山东省肿瘤医院肺部肿瘤胸部异常摄取”Tcm-MDP的患者260例,行常规全身骨显像,按病变性质分为A(单纯肺部肿块78例)、B(胸腔积液55例)、C(胸膜累及54例)、D(胸膜累及合并胸腔积液73例)和E(明确为肋骨转移42例)组.在异常放射性浓集区用感兴趣区(region of interest,ROD技术分别勾画出病侧肋骨(A、B、C和D组避开肋骨转移部位)及肋间(target,T)以及对侧相应正常部位(non target,NT)的总放射性计数,行T/NT和相关计算进行统计学分析.结果 胸部5种不同性质病变的T/NT(x±s)值均＞1.3,5种病变均不同程度摄取99Tcm-MDP,其形态各异.5组肋骨的T/NT,仪E组与其他4组比较差异有统计学意义,余各组间P值均＞0.05.A、B、C和D4组肋间的T/NT,仅AB组差异有统计学意义(P=0.04),余各组间P值均＞0.05.各组的病灶侧肋骨计数(x)减去病灶侧肋间计数(y)与对侧正常侧肋骨计数(z)相比,仅E组与其他4组比较差异有统计学意义,均P值均＜0.05.结论 肋骨转移及不同性质肺部病变均可异常摄取99Tcm-MDP,但其程度及形态有差异;通过定量分析处理,可在一定程度上区别胸部病变的性质.

Quantitative analysis of lung diseases in 99 Tcm-MDP bone scintigraphy

OBJECTIVE Although bone scintigraphy is a routine examination for cancer patients,there is also accumulation of imaging agent by the outer-bone soft tissue such as pulmonary lesions.Our purpose was to quantitatively analyze and precisely diagnose the abnormal radioactive uptake of 99Tcm MDP in patients with different lung diseases.METHODS All 260 patients with lung tumor was enrolled,in whom whole-body bone scintigraphy revealed abnormal thoracic uptake of radiotracer.According to different lesion models,the patients were divided into 5 groups:78 cases with pulmonary masses only (group A),55 cases with pleural effusion(group B),54 cases with pleural thickening (group C),73 cases with both pleural effusion and pleural thickening (group D),in which 42 cases confirmed rib metastases (group E).The total radioactive counts ratio in regions of interest (ROD on rib and intercostal of lesion side and contralateral symmetry area (T/NT) were calculated for further statistically analysis.RESULTS Bone scintigraphy revealed the vary of 99Tcm-MDP accumulation in chest in these 5 groups.The T/NT values (x±s) of 5 different kinds of lesions in chest were all larger than 1.3.T/NT rib ratio of 5 groups revealed that there were statistically significant difference between E and other 4 groups,while the other 4 groups remained no significant differences.There was statistically signif icant difference between group A and B in intercostal T/NT,while no difference among other groups.The value,(x-y)/z,counts of affected ribs (x) minus ipsilateral intercostal counts (y) were divided by the contralateral rib counts (z).There were statistically significant differences between E and other groups.CONCLUSIONS This study indicated that there were all high uptake of 99 Tcm-MDP in rib metastases,pulmonary masses,thickening of the pleura and pleural effu sion,but varied in degree.The Pathological characteristics of chest lesions could be differentiated by statistical analysis to a certain extent.