前列腺癌骨转移的临床与影像学特点对前列腺癌的诊断价值

目的:分析前列腺癌骨转移的临床与影像学表现,探讨其对前列腺癌的诊断价值.方法:对24例经病理证实的前列腺癌骨转移病例的影像学表现进行了回顾性分析.结果:24例前列腺癌骨转移病例中,多发性骨转移21例,单发性骨转移3例;成骨型骨转移18例,约占75%,混合型骨转移6例,约占25%.转移部位以骨盆、脊椎等中轴骨的多发性成骨转移为主,骨盆16例,胸、腰椎15例.结论:多种影像学检查方法的联合应用有利于发现和诊断前列腺癌的骨转移,对前列腺癌的诊断和治疗具有重要意义.     

转移性骨肿瘤的影像学诊断进展

转移性骨肿瘤是由原发于骨外的恶性肿瘤,通过血液、淋巴系统播散到骨骼系统的继发性恶性肿瘤,多发生于40岁以上的中老年患者。最易发生骨转移的肿瘤有前列腺癌、肺癌、乳腺癌、甲状腺癌和肾癌等。骨转移瘤的存在与否对肿瘤分期及制定最佳治疗方案等有非常重要的意义,因此,早期发现并及时有效的治疗可以明显改善患者的生活质量,提高生存率。影像学检查是目前临床诊断骨转移瘤最常用的一种手段,检查方法主要包括X线、CT、磁共振成像(MRI)及核     

乳腺癌骨转移的影像学诊断进展

乳腺癌是“嗜骨性癌肿”,极易伴发骨转移,由骨转移引发的骨相关事件可明显影响晚期乳腺癌患者的生存质量及预后转归。因此,早期、准确诊断骨转移对乳腺癌的临床分期及治疗计划制定具有决定作用,对预后改善亦有重要意义。该文综述了乳腺癌骨转移影像学诊断的研究进展,为临床早期诊断骨转移提供影像学依据。     

核素骨显像对诊断前列腺癌骨转移的临床价值

核素骨显像对诊断前列腺癌骨转移的临床价值陈雅清，屈婉莹，朱明前列腺癌是男性老年人的常见病，临床症状多不典型，但骨转移率高．前列腺癌骨转移者作睾丸切除和激素治疗，大多数可获较满意的疗效，因此，早期诊断至关重要．本文对４２例前列腺癌骨转移患者的核素骨显像...     

长骨转移瘤的影像学诊断

目的探讨长骨转移瘤的影像学特点,提高诊断准确率。方法选择具有明确原发病史或病理证实的45例长骨转移瘤患者为研究对象,对其骨转移瘤病灶的X线、CT和MRI影像表现进行回顾性总结及分析。其中X线检查18例,CT检查26例,MR检查18例(部分患者同时做2种或3种检查)。结果 X线发现20处病灶的基本特点为呈不规则形、多发斑点虫蚀样破坏或类椭圆形透亮区。无论累及骨端还是累及骨干病变,均伴有周围骨质破坏,并部分相邻皮质伴有不连续条带状骨膜增生。CT发现27处病灶均呈溶骨性骨质破坏,破坏范围可单侧或四周,部分周围形成软组织肿块。累及骨干分为皮质型和常见型。MRI发现20处病灶表现为长T1长T2、压脂像为高信号。结论长骨转移瘤在影像学表现上具有多样化特点,具体在X线、CT、MRI表现各自具有其特征性。相对而言CT、MRI在敏感性方面显示出较显著优势,尤其是MRI在发现早期髓腔病变具有较高敏感性。但X线检查在骨膜反应方面则优于其他检查。若将X线、CT和MRI三者相结合进行综合分析验证,对于诊断长骨转移瘤和与骨其他病变相鉴别具有显著意义,可提高诊断准确率。     

PET在前列腺癌中的应用

前列腺癌是老年男性最常见的恶性肿瘤之一,PET在其早期诊断和准确分期方面具有重要价值。18F-氟代脱氧葡萄糖(18F-FDG)PET对前列腺癌的检出并不敏感,也不能可靠进行淋巴结分期,但18F-FDG摄取与疾病进展程度相关。11C-胆碱PET诊断前列腺癌的准确率高,在淋巴结及骨转移的检出方面也明显优于18F-FDGPET,但其半衰期短而限制了临床应用。18F-胆碱的肿瘤摄取与11C-胆碱相似,但在泌尿系统排泄较高。其他示踪剂如11C-乙酸、11C-甲硫氨酸、18F标记的雄激素等在前列腺癌的诊断、分期及疗效评价方面也具有一定价值。     

18F-FDG PET-CT与99Tcm-MDP骨显像对骨转移瘤诊断价值的对比研究

目的比较18F-FDG PET-CT和99Tcm-MDP全身骨显像对骨转移瘤的诊断价值。方法经病理学证实为恶性肿瘤且临床怀疑合并骨转移的患者32例,均行全身18F-FDG PET-CT扫描和99Tcm-MDP全身骨显像(检查间隔时间在2周之内)。比较相同扫描野内两者对骨转移病灶检出的敏感性、特异性及准确性。结果PET-CT对骨转移瘤诊断的敏感性、特异性及准确性分别为94.9%、91.7%和94.1%,骨显像分别为96.2%、54.2%和86.3%。18F-FDGPET-CT对骨转移瘤的诊断特异性高于99Tcm-MDP骨显像,敏感性和准确性二者无显著差异。结论18F-FDG PET-CT与99Tcm-MDP骨显像相比,对骨转移瘤的诊断特异性较高,对肿瘤良恶性的鉴别优于骨显像。     

放射性核素治疗多发性骨转移癌的临床观察

人体内其他组织或器官的恶性肿瘤通过一定途径侵犯骨组织所致的肿瘤称为骨转移瘤。临床上有许多肿瘤(如乳腺癌、肺癌、前列腺癌等)容易发生转移瘤。骨转移瘤的转移途径有直接蔓延和血行转移，以后者为主。早期确定有无骨转移，对于治疗方案和预后有重要的价值。     

骨转移瘤影像学早期诊断现状及进展

骨转移瘤是指恶性肿瘤通过各种途径转移至骨内,并在骨内继续生长形成的子瘤,是骨肿瘤中的常见类型。随着恶性肿瘤发病率的增加、治疗效果的改善,患者生存期的延长,骨转移发生率明显增加。早期检出骨转移瘤对恶性肿瘤的临床分期、治疗方案的合理选择及预后判断有重要意义。现将骨转移瘤影像学早期诊断现状及进展综述如下。     

18F-FDG PET/CT对原发灶不明的骨转移瘤的诊断价值

目的探讨18F-FDGPET/CT对原发灶不明的骨转移瘤的诊断价值。资料与方法回顾性分析经病理证实的72例原发灶不明的骨转移瘤患者的PET/CT资料,记录原发灶部位、骨转移部位及骨外转移部位(包括前哨淋巴结及脏器)并按CT骨转移诊断标准进行分类,测量其最大标准摄取值。结果 PET/CT显像检查确定61例原发灶,11例未找到原发灶。66例为多发骨转移,6例为单发骨转移;原发灶部位依次为肺癌(31例)、前列腺癌(6例)、胃癌(4例)、结肠癌(3例)、甲状腺癌(3例)等;溶骨性转移以肺癌(22例)、胃肠癌(7例)多见,成骨性骨转移以前列腺癌(5例)、肺癌(4例)多见,混合性骨转移以肺癌(5例)、鼻咽癌(2例)多见;胸部骨及脊柱转移多见肺癌(31例),骨盆及脊柱转移多见肺癌(23例)、前列腺癌(6例)。结论 PET/CT诊断原发灶不明的骨转移瘤时,需根据骨转移的类型、部位及前哨淋巴结和脏器转移的位置找出原发灶,必要时进一步行穿刺活检明确诊断。     

Dynamic contrast-enhanced MR imaging findings of bone metastasis in patients with prostate cancer

AIM:To evaluate the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) findings of bone metastasis in prostate cancer patients.METHODS:Sixteen men with a diagnosis of metastatic prostate cancer to bones were examined with DCE-MRI at 1.5 Tesla.The mean contrast agent concentration vs time curves for bone metastasis and normal bone were calculated and K trans and ve values were estimated and compared.RESULTS:An early significant enhancement (wash-out:n=6,plateau:n=8 and persistent:n=2) was detected in all bone metastases (n=16).Bone metastasis from prostate cancer showed significant enhancementand high K trans and ve values compared to normal bone which does not enhance in the elderly population.The mean K trans was 0.101/mmiinn and 0.0051/mmiinn (P < 0.001),the mean ve was 0.141 and 0.0038 (P < 0.001),for bone metastases and normal bone,respectively.     

18F-FDG PET-CT诊断前列腺癌复发与转移的价值

目的 探讨18F-FDG PET-CT在前列腺癌复发、转移诊断中的价值.方法 回顾性分析23例前列腺癌治疗后随访期间临床怀疑复发、转移患者的18F-FDG显像资料,同期常规显像检查结果,病理及临床随访结果.结果 经病理及临床随访结果证实前列腺癌复发、转移者19例.PET-CT诊断为阳性者20例,其中1例盆腔脓肿、5例前...     

大范围扩散加权成像与骨扫描对照评价前列腺癌骨转移的前瞻性研究

目的 评价大范围(从头顶到小腿)MR DWI在前列腺痈骨转移瘤检测中的应用.方法 搜集接受前列腺MR检查的166例连续患者,所有患者均行前列腺局部扫描及大范围DWI.其中49例在1个月内接受骨扫描检查和大范围DWI并行双盲法诊断.以常规T1WI和压脂T2WI为标准,确定骨转移瘤的存在及其位置.49例均为MRI和核素检查后获得前列腺的穿刺病理结果.大范围DWI与骨扫描对骨转移瘤诊断的敏感度、特异度、受试者操作特征曲线(ROC曲线)下面积应用McNemar检验进行比较.转移瘤患者中有5例有>10处/例的全身多发骨转移,在以病灶为单位研究时不纳入计算.结果 49例中10例有骨转移瘤,而DWI和核素骨扫描分别诊断15和17例有骨转移瘤,大范围DWI和核素骨扫描诊断骨转移瘤的敏感度均为100%(10/10),特异性分别为87.2%(34/39)和82.1%(32/39),ROC曲线下面积分别为0.936和0.910.44例患者中2种技术共显示68处异常信号和(或)放射浓聚灶,有20处被证实为骨转移瘤,而DWI显示其中23处为骨转移瘤,核素骨扫描显示其中34处为骨转移瘤.以病灶为单位(68处)计算大范围DWI和核素骨扫描诊断骨转移瘤灶的敏感度均为90.0%(18/20),特异度分别为89.6%(43/48)和66.7%(32/48),ROC曲线下面积分别为0.898和0.783,大范围DWI的特异度高于骨扫描(P<0.01),ROC曲线下面积也高于核素骨扫描(P<0.05).结论 大范围DWI可用于前列腺癌骨转移瘤的检查,特异度和准确度高于骨扫描.     

A review of the efficacy of bone scanning in prostate and breast cancer.

Bone scintigraphy has provided valuable data in the assessment and management of neoplastic disease since being first described in the early 1960s. There have been many developments in imaging techniques and radiopharmaceuticals over the years allowing more reliable detection of metastatic spread to bone. Other imaging modalities are also evolving roles in the detection of metastatic spread including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). Despite this, isotope bone scans continue to have a central role in detection and surveillance of bone metastases in breast and prostate cancer. Paralleling developments in imaging there have been enormous changes in the treatment options available for cancers of the breast and prostate that have metastasised to bone. Bone specific treatments including radionuclides and bisphosphonates as well as high dose chemotherapy provide potential improvement in disease control. There is also evidence that earlier treatment of bone metastases may prolong survival. This increases the need for efficient methods of detection and monitoring of disease. In this article we discuss the efficacy of bone scintigraphy in breast and prostate cancer from the point of view of staging, systematic follow-up of asymptomatic patients, evaluation of symptomatic patients and the assessment of response to therapy.     

颅内间变性血管外皮细胞瘤伴骨转移一例

笔者报道了1例颅内间变性血管外皮细胞瘤（AHPC）伴骨转移的病例，从临床表现、影像学检查尤其是全身骨显像检查以及术后病理综合分析了该病特点。并通过文献复习加深了对AHPC骨转移的认识。多数恶性肿瘤常见骨转移，而颅内AHPC是一种少见的中枢神经系统肿瘤，较少发生骨转移。通过全身骨显像发现了该例患者多处骨骼病变，术后病理提示颅内AHPC骨转移，因此提示恶性肿瘤尤其是少见骨转移者应把骨显像检查作为随访的一个重要检查，对于早期发现骨转移、确定临床分期及治疗方案的选择等都是至关重要的。     

SPECT/低剂量CT融合显像技术在肺癌骨转移诊断中的应用

目的探讨SPECT/低剂量CT融合显像在肺癌骨转移诊断中的应用价值。方法选取59例肺癌疑似骨转移患者行99m Tc-MDP全身骨显像及SPECT/低剂量CT融合显像,以随访结果或活检病理学检查结果为诊断标准,比较两种检查方式诊断骨转移的灵敏度,特异度,准确率,阴性、阳性预测值,并分析肺癌骨转移影像学表现。结果1)59例肺癌患者疑似骨转移病灶146处,经随访确诊肺癌骨转移病灶115处,其中发生于脊椎51处,占44.35%,胸廓30处,26.09%,骨盆16处,占13.91%,四肢11处,占9.56%,颅骨7处,占6.09%;2)SPECT/低剂量CT融合显像诊断肺癌骨转移灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为:99.13%、93.55%、98.28%、93.55%、97.95%,均高于SPECT全身显像的97.39%、67.74%、91.80%、87.5%、91.10%,其中特异度、阳性预测值及准确率差异有统计学意义(Fisher=10.144、5.688、7.101,P<0.05);3)鳞癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为42.86%、28.57%、14.29%、7.14%、7.14%;溶骨性、成骨性骨破坏分别为75.00%、25.00%;腺癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为46.34%、26.83%、13.41%、7.32%、6.10%;溶骨性、成骨性骨破坏分别为68.29%、30.49%,鳞癌、腺癌骨转移部位及骨破坏类型差异无统计学意义(P>0.05)。结论SPECT/低剂量CT融合显像在鉴别诊断肺癌骨转移方面具有良好临床价值,肺腺癌骨转移发生率较高。     

Imaging prostate cancer: a multidisciplinary perspective

The major goal for prostate cancer imaging in the next decade is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. No consensus exists regarding the use of imaging for evaluating primary prostate cancers. Ultrasonography is mainly used for biopsy guidance and brachytherapy seed placement. Endorectal magnetic resonance (MR) imaging is helpful for evaluating local tumor extent, and MR spectroscopic imaging can improve this evaluation while providing information about tumor aggressiveness. MR imaging with superparamagnetic nanoparticles has high sensitivity and specificity in depicting lymph node metastases, but guidelines have not yet been developed for its use, which remains restricted to the research setting. Computed tomography (CT) is reserved for the evaluation of advanced disease. The use of combined positron emission tomography/CT is limited in the assessment of primary disease but is gaining acceptance in prostate cancer treatment follow-up. Evidence-based guidelines for the use of imaging in assessing the risk of distant spread of prostate cancer are available. Radionuclide bone scanning and CT supplement clinical and biochemical evaluation (prostate-specific antigen [PSA], prostatic acid phosphate) for suspected metastasis to bones and lymph nodes. Guidelines for the use of bone scanning (in patients with PSA level > 10 ng/mL) and CT (in patients with PSA level > 20 ng/mL) have been published and are in clinical use. Nevertheless, changes in practice patterns have been slow. This review presents a multidisciplinary perspective on the optimal role of modern imaging in prostate cancer detection, staging, treatment planning, and follow-up.     

Improved detection of skull metastasis with diffusion-weighted MR imaging

BACKGROUND AND PURPOSE: Metastasis to the skull is clinically important, but routine MR imaging offers moderate sensitivity for skull-metastasis detection in our experience. We sought to determine if diffusion-weighted MR imaging (DWI) could improve the detection of skull metastasis in patients with primary carcinomas that metastasized to bone compared with conventional MR imaging. MATERIALS AND METHODS: Seventy-five patients from the tumor registry of our institution with extracranial primary malignancy who had brain MR imaging with DWI and radionuclide bone scanning (RNBS, gold standard) within a 6-week interval were evaluated. Thirty-eight patients demonstrated increased radiopharmaceutical uptake on RNBS, consistent with skull metastasis of any size, and the remaining 37 were control subjects. Two readers correlated the DWI and conventional MR imaging with RNBS. RESULTS: The overall sensitivity of DWI for detection of skull metastases was 68.4%-71.1% (kappa=0.68) versus 42.1%-55.3% (kappa=0.65) for conventional MR imaging. Breast cancer (n=20) was detected with greatest sensitivity of 86.7%-93.3% (kappa=0.80) for DWI versus 60%-80% (kappa=0.5) for conventional MR imaging. Lung cancer (n=32) was detected with 63.6%-72.7% sensitivity (kappa=0.56), and prostate cancer (n=8) with 14.3% sensitivity (kappa=0.5) for DWI versus 27.3%-36.4% (kappa=0.81) and 14.3-42.9% (kappa=0), respectively, for conventional MR imaging. CONCLUSIONS: DWI is a useful sequence for identifying focal skull metastases for breast and lung malignancies and, compared with conventional MR imaging, provides improved detection of these lesions. DWI is insensitive for detecting skull metastases from prostate carcinoma.     

562例原发肺癌患者核素骨显像结果分析

目的 通过核素骨显像检查,探讨不同病理组织学类型肺癌的骨转移规律。方法 对562例已确诊的原发肺癌患者进行99Tcm-亚甲基二膦酸盐(99Tcm MDP)全身骨显像,对骨显像的结果和肺癌病理类型进行回顾性分析。结果 各类型肺癌骨转移平均发生率为43.06%,肺腺癌和小细胞癌骨转移率较高,分别为55.43%和45.16%,腺鳞癌、鳞癌骨转移发生率分别为37.93%和35.19%。结论 肺癌骨转移发生率较高,肺腺癌和小细胞癌较其他类型肺癌更易发生骨转移;核素全身骨显像是诊断肺癌早期骨转移的首选方法,对帮助判断疾病的进展程度,选择合适的治疗方案,改善患者的生存质量和延长生命有重要的临床意义。