乳腺癌骨转移临床相关因素的研究

Objective To study the clinical and imaging features of patients with bone metastases from breast cancer and identify the factors related to the incidence of bone metastases. Methods Three hundred and thirty-four patients with breast cancer were recruited into this study. Whole-body 99Tcm-methylene disphosphonate (MDP) bone scan, clinical staging, pathological, immunohistochemical and serological test results were analyzed retrospectively. χ2 test was used for statistical analysis. Results The incidence rate of bone metastases for patients with and without lymph node metastases was 71% (152/214) and 22. 5% (27/120), respectively (χ2 =72.80, P =0.000). The incidence rate of bone metastases from infiltrated non-specified and specified breast cancer was 69% (203/294) and 41.7% (5/12), respectively (χ2 =3. 97, P=0.046). Alkaline phosphatase (ALP) was elevated in 28.5% (51/179) and 14.9%(11/74) of patients with and without bone metastases, respectively (χ2 = 5. 25, P = 0.022 ). Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, CA125, CA19-9 increased in 68.7% ( 123/179) and 27.0% (20/74) of patients with and without bone metastases, respectively (χ2 = 37. 03, P =0. 000). Conclusions The incidence of bone metastases from breast cancer is correlated to pathological types of primary tumor and lymph node metastases. Bone metastases occurs more frequently in patients with infiltrated, non-specified, primary cancer and with lymph node metastases. Serum ALP, CEA, CA15-3,CA125, CA19-9 might be the tumor makers for early diagnosis of bone metastases from breast cancer.     

Melanoma metastases in the abdomen and pelvis: Frequency and patterns of spread

AIM: To investigate the frequency, typical and atypical locations and patterns of melanoma metastases identifiable by computed tomography (CT) in the abdomen and pelvis. METHODS: We performed a retrospective review of index CT examinations of the abdomen and pelvis in patients with melanoma and recorded all findings suggestive of metastatic disease. RESULTS: Metastases were present on 36% (181/508) of the index examinations and most commonly involved the liver (47%) and pelvic lymph nodes (27%). Lower extremity primaries had the highest rate of metastasis (52%). Ocular and head and neck melanomas have a predilection to metastasize to the liver (hepatic involvement in 70% and 63%, respectively, of patients with metastatic disease) and metastases from lower extremity primaries most commonly involve pelvic lymph nodes (54% of patients with metastatic disease). Metastases to atypical locations were present in 14% of patients and most commonly occurred in the subcutaneous tissue and spleen. Primary tumors of the lower extremity, back and head and neck were most commonly associated with atypical metastases. Pelvic metastases are more common with lower extremity primaries (accounting for 70% of cases with pelvic metastases) but 5% of patients with supraumbilical primaries also had pelvic metastases. CONCLUSION: The distribution of metastatic melanoma in the abdomen and pelvis that we have defined should help guide the interpretation of CT exams in these patients.     

骨原发性淋巴瘤影像分析

目的 分析原发性骨淋巴瘤(PLB)及"浮冰征"的影像表现和病理基础.方法 回顾性分析经病理证实且临床资料齐全的41例PLB患者的临床与影像特征.41例全部行X线检查,20例行CT检查,12例行MR检查(3例同时行增强扫描).结果 41例PLB中位于扁骨12例,脊柱8例,长骨17例,其他不规则骨4例.发病最多的部位是股骨(10例,24.4%),其次为髂骨(8例,19.5%).长骨病变位于骨干干骺处者11例.41例中无骨膜反应者37例(90.2%).CT显示骨质破坏轻微而出现软组织肿块者12例,伴有明显软组织肿块者9例,出现"浮冰征"者4例.12例MR检查结果中,10例显示软组织肿块,MRI显示病变范围全部大于CT所显示病变范围,其中1例MRI显示大范围骨质异常,但平片及CT显示骨质破坏不明显.结论 (1)骨质破坏轻而软组织肿块明显,或MRI显示骨质异常范围明显超过平片及CT所见,或MRI显示骨质异常而平片及CT显示骨质破坏较轻或未见明显骨质破坏者提示PLB.(2)"浮冰征"是PLB较为特殊的一种征象,其出现对淋巴瘤的诊断具有一定提示意义.

Abstract：

Objective To analyze the imaging features of primary lymphoma of the bone,and discuss the special feature of the "floating ice sign". Methods Forty-one cases of primary lymphoma of the bone in our unit from 1963.1-2009.6 were retrospectively studied. All 41 patients underwent X-ray examination, and 20 patients underwent CT examination, 12 patients underwent MR examination (3 cases simultaneously with enhancement).Results Involvement of the flat bone was seen in 12 cases. Vertebral column was affected in 8 cases, and 17 cases showed lesions in long bones and irregular bones were involved in 4 cases. The most common location was the femur(10, 24.4%), followed by the ilium(8, 19.5%). Lesions were found in the metaphyses of the long bone in 11 cases (64.7%). "Floating ice sign" was showed in the calcaneus of 2 patients and in the lumbar vertebra of 2 cases respectively, accounted for 9.8% of all cases. Slight bone destruction with soft tissue mass on CT image could be found in 12 cases, while obvious soft tissue mass was found in 9 cases. No periosteal reaction was found in 37 cases (90.2%). MRI examinations of 12 patients revealed soft tissue mass in 10 patients, and the extent of the lesion was larger in MR than CT. One case showed extensive bone destruction on MR but inconspicuous bone destruction on X-ray plain film and CT scan. Conclusion Slight bone destruction with conspicuous soft tissue mass, conspicuous bone destruction on MR but slight or inconspicuous bone destruction on X-ray film and CT,could strongly imply the diagnosis of primary lymphoma of the bone. "Floating ice sign" was a special imaging feature of primary lymphoma of the bone, which could be used as a clue for the diagnosis of lymphoma.     

耳鸣患者颞骨异常的CT及MRI研究

目的 采用HRCT和MRI对耳鸣患者颞骨进行检查,探讨其异常发生率及最佳扫描方案.方法 回顾性分析1015例耳鸣患者的HRCT和MRI资料.搏动性耳鸣145例,142例行HRCT,7例行MRI,其中4例同时行HRCT和MRI,仅行平扫HRCT者67例,仅行增强HRCT者71例.非搏动性耳鸣870例,650例行HRCT,267例行MRI,其中47例同时行HRCT和MRI,仅行平扫HRCT者598例,仅行增强HRCT者5例.分析颞骨异常阳性率及构成比,比较不同影像学检查方法和序列对颞骨异常的显示效果.采用χ2检验对数据进行组间分析.结果 1015例中显示病变者767例(75.57%).常见颞骨异常发生率分别为:颈静脉窝高位414例(40.79%);乙状窦异常387例(38.13%);中耳乳突炎148例(14.58%);中颅窝低位70例(6.90%).平扫HRCT对颈静脉窝高位显示阳性率最高(365/665,54.89%);增强HRCT对乙状窦异常显示的阳性率最高(56/76,73.68%).在搏动性耳鸣患者中,乙状窦异常发生率最高(96/145,66.21%),且其发生率明显高于非搏动性耳鸣患者(291/870,33.45%;χ2=56.537,P＜0.01).真稳态进动快速成像(FIESTA)序列显示内耳道内血管袢影最佳(42/42,100%).结论 颈静脉窝高位和乙状窦异常是耳鸣患者最常见的颢骨影像异常.搏动性耳鸣首选增强HRCT,非搏动性耳鸣首选平扫HRCT,内耳道内血管显示首选MR FIESTA序列.

Abstract：

Objective To study high resolution CT (HRCT) and MRI findings of temporal bone anomaly in patients with tinnitus and identify the optimal examination method in the detection of the anomaly. Methods The HRCT and MRI data were analyzed retrospectively in 1015 patients including 145 patients with pulsatile tinnitus (PT) and 870 patients with nonpulsatile tinnitus (NPT). The positive rates of HRCT and MRI in the identification of temporal bone anomaly were analyzed and the efficiency of various examination methods was compared in revealing the anomaly. Data were tested by Chi-square test analysis. Results Among 1015 patients, anomaly was seen in 767 cases (75.57%). High jugular bulb was found in 414 patients, accounting for 40. 79%. Sigmoid sinus anomaly was detected in 387 patients (38. 13%), while otitis media was found in 148 cases (14. 58%), and low middle cranial fossa in 70 cases (6. 90%). The positive rate of HRCT in the detection of high jugular bulb was 54. 89% (365/665), which was significantly higher than those of other methods (P ＜ 0. 05). The positive rate of enhanced HRCT in showing sigmoid sinus anomaly was 73.68% (56/76), which was significantly higher than those of other methods(P ＜0. 05). Sigmoid sinus anomaly was the most frequent finding in patients with PT, accounting for 66. 21% (96/145). The incidence of sigmoid sinus anomaly was higher in PT than in NPT (291/870,33.45% ;χ2 =56. 537 ,P ＜0. 01). The fast imaging employing steady-state acquisition (FIESTA) sequence was the best examination method in displaying the vessel within the internal auditory canal (42/42,100%).Conclusions High jugular bulb and sigmoid sinus anomaly were the most frequent abnormal findings of temporal bone in patients with tinnitus. Enhanced HRCT was the choice of modality in patients with PT.Plain HRCT was recommended for NPT. FIESTA sequence was the best in the evaluation of the vessel within the internal auditory canal.     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

前瞻性心电门控双源CT冠状动脉成像在高心率患者中应用的可行性研究

Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).     

Whole-body magnetic resonance imaging for detecting bone metastases: comparison with bone scintigraphy

Purpose

The aim of the study was to assess the reliability of whole-body magnetic resonance imaging (WB-MRI) in detecting skeletal metastasis and to compare the results with those of bone scintigraphy (BS).

Materials and methods

Thirty-three patients (21 women, 12 men, median age 58 years, range 27–78) were enrolled. Histological proof of malignancy was obtained in all cases. The primary tumour was unknown in 1 patient. BS and WB-MRI were performed as staging procedures in 15 patients, during the follow-up in 6 and to investigate pain in 9 and neurological symptoms in 3. Bone metastases were recorded for 8 different skeletal segments (ribs, skull, cervicothoracic spine, lumbosacral spine, clavicle-scapula-sternum, pelvis, upper extremities and lower extremities) in all patients, for a total of 264 examined areas.

Results

Bone metastases were detected in 18 patients (55%). In 15/33 patients, WB-MRI and BS were concordantly negative. BS revealed focal metastatic uptake in 72%, whereas WB-MRI was positive in 89%. Results differed in seven patients. WB-MRI was positive but BS was negative in five cases. Two patients with negative WB-MRI had focal and intense uptake in the ribs on BS. Out of 264 examined areas, bone metastases were detected in 34 (13%). WB-MRI revealed tumour spread in 26/34 areas (76%) and BS in 21/34 areas only (62%).

Conclusions

WB-MRI is a reliable method for screening patients with suspected skeletal metastases, although BS still remains a useful tool. WB-MRI is also advantageous because it reveals extraskeletal and soft tissue metastases.     

尿I型胶原氨基末端肽辅助骨显像诊断恶性肿瘤骨转移的价值

目的探讨应用尿I型胶原氨基末端肽（uNTX）辅助骨显像诊断恶性肿瘤骨转移的价值。方法选取227例骨显像诊断为可疑骨转移患者,首先测定患者的uNTX,并以其正常参考值上限65nmo]骨胶原当量（BCE）／mmol肌酐（Cr）作为辅助诊断骨转移的临界点：当uNTX〉65nmolBCE／mmolCr判断为骨转移,反之为非骨转移。同时综合CT、MRI、PET／CT等检查进行骨转移的确诊。应用单样本或两样本t检验比较组间uNTX差异;利用ROC曲线对uNTX辅助骨显像诊断骨转移的效能进行评价,确立实验诊断的最佳切点值,并以其为甄别骨转移的标准进行回顾性评价,计算诊断效能。结果227例患者的uNTX为（84．30±13．29）nmolBCE／mmolCr,高于正常参考值上限65nmolBCE／mmolCr（t=21．875．P〈O．01）。UNTX〉65nmolBCE／mmolCr者197例,其中188例由综合检查诊断法确诊为骨转移;UNTX〈65nmolBCE／mmolCr者共30例,其中27例由综合检查诊断法确诊非骨转移。综合检查诊断法确诊为骨转移（191例）与非骨转移（36例）患者的uNTX分别为（88．73±8．37）和（60．76±9．14）nmolBCE／mmolCr（t=-18．134,P〈O．01）。UNTX值辅助骨显像诊断骨转移的灵敏度、特异性、阳性预测值、阴性预测值、准确性、约登指数分别为98．4％（188／191）、75．0％（27／36）、95．4％（188／197）、90．0％（27／30）、94．7％（215／227）、73．4％,曲线下面积0．982;通过ROC曲线确立最佳切点值为78．88nmolBCE／mmolCr,以此切点值为甄别骨转移的界值进行回顾性评价：灵敏度、特异性、阳性预测值、阴性预测值、准确性、约登指数分别为97．4％（186／191）、94．4％（34／36）、98．9％（186／188）、87．2％（34／39）、96．9％（220／227）、91．8％。结论该研究获得的uNTX最佳切点值可以对骨显像中的疑似骨转移病例进行有效甄别,具有较高的临床应用价值。     

Fundamental study of the detection of metastatic bone tumors with whole-body MR imaging]

Preliminary studies were performed to evaluate the usefulness of whole-body magnetic resonance imaging (WB-MRI) in the screening of bone metastases. The fast short TI inversion recovery sequence was the most suitable method because of its minimal image distortion and uniformity of fat suppression in a large field of view. In 4 cases of malignant tumor, the localization of all 8 bone metastases detected with bone scintigraphy (BS) could be clarified with WB-MRI. Furthermore, WB-MRI with fast STIR alone could depict 4 lesions undetected by BS, and WB-MRI combined with contrast enhancement could depict 5 such lesions.     

Whole-body MRI at 1.5 T and 3 T compared with FDG-PET-CT for the detection of tumour recurrence in patients with colorectal cancer

The purpose of this study was to assess the diagnostic accuracy of whole-body MRI (WB-MRI) at 1.5 T or 3 T compared with FDG-PET-CT in the follow-up of patients suffering from colorectal cancer. In a retrospective study, 24 patients with a history of colorectal cancer and suspected tumour recurrence underwent FDG-PET-CT and WB-MRI with the use of parallel imaging (PAT) for follow-up. High resolution coronal T1w-TSE and STIR sequences at four body levels, HASTE imaging of the lungs, contrast-enhanced T1w- and T2w-TSE sequences of the liver, brain, abdomen and pelvis were performed, using WB-MRI at either 1.5 T (n = 14) or 3 T (n = 10). Presence of local recurrent tumour, lymph node involvement and distant metastatic disease was confirmed using radiological follow-up within at least 5 months as a standard of reference. Seventy seven malignant foci in 17 of 24 patients (71%) were detected with both WB-MRI and PET-CT. Both investigations concordantly revealed two local recurrent tumours. PET-CT detected significantly more lymph node metastases (sensitivity 93%, n = 27/29) than WB-MRI (sensitivity 63%, n = 18/29). PET-CT and WB-MRI achieved a similar sensitivity for the detection of organ metastases with 80% and 78%, respectively (37/46 and 36/46). WB-MRI detected brain metastases in one patient. One false-positive local tumour recurrence was indicated by PET-CT. Overall diagnostic accuracy for PET-CT was 91% (sensitivity 86%, specificity 96%) and 83% for WB-MRI (sensitivity 72%, specificity 93%), respectively. Examination time for WB-MRI at 1.5 T and 3 T was 52 min and 43 min, respectively; examination time for PET-CT was 103 min. Initial results suggest that differences in accuracy for local and distant metastases detection using FDG-PET-CT and WB-MRI for integrated screening of tumour recurrence in colorectal cancer depend on the location of the malignant focus. Our results show that nodal disease is better detected using PET-CT, whereas organ disease is depicted equally well by both investigations.     

ROC曲线评价18F—FDGPET／CT、99Tcm—MDP骨显像及二者联合对骨转移的检出效能

目的采用ROC曲线比较18F-FDGPET／CT、99TcmMDP骨显像及二者联合对骨转移患者的检出效能。方法296例恶性肿瘤患者在2个月内同时接受了18F-FDGPET／CT和99TcmMDP骨显像,对2种显像结果按5分法（0分：骨转移阴性,1分：可能阴性,2分：不能确定,3分：可能阳性,4分：肯定阳性）分别评分,两者之和为联合评分值。以病理诊断或临床随访为确诊“金标准”,采用。检验比较ROC曲线下面积,以评价骨显像、PET／CT及联合评分法对骨转移患者的检出效能,采用r检验比较不同方法在各自最佳诊断阈值下的灵敏度、特异性、准确性、阳性预测值、阴性预测值。结果296例患者中,确诊骨转移阳性61例（占20．6％）、阴性235例（占79．4％）。骨显像、PET／CT及联合评分诊断骨转移的ROC曲线下面积（95％可信区间）分别为0．919（0．867—0．971）、0．949（0．906～0．991）、0．994（0．988～0．999）,联合评分法的曲线下面积明显大于骨显像（z=2．866,P=0．004）和PET／CT（z=2．027,P=0．043）各自单独评分法,骨显像和PET／CT法曲线下面积差异没有统计学意义（z=0．881,P=0．378）。最佳阈值点下,骨显像和PET／CT单独检出骨转移患者的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为90．2％（55／61）、85．1％（200／235）、86．1％（255／296）、61．1％（55／90）、97．1％（200／206）和88．5％（54／61）、97．0％（228／235）、95．3％（282／296）、88．5％（54／61）、97．0％（228／235）,而联合评分检出的结果分别为98．4％（60／61）、95．7％（225／235）、96．3％（285／296）、85．7％（60／70）、99．6％（225／226）。PET／CT对骨转移患者检出的特异性（X2=19．600,P〈0．001）、准确性（X2=13．755,P〈0．001）、阳性预测值（x2=13．608,P〈0．001）均高于骨显像,灵敏度（r=0,P=1．000）差异无统计学意义;与骨显像、PET／CT单独评分比较,联合评分法检出的特异性（X2=19．862,P〈0．001）、准确性（x2=23．361,P〈0．001）和阳性预测值（x2=11．791,P=0．001）均明显高于骨显像,灵敏度明显高于PET／CT（x2=4．167,P=0．031）。结论18F—FDGPET／CT对骨转移患者的检出效能优于99Tcm—MDP骨显像,二者联合明显提高了对骨转移患者的检出率。     

The value of bone marrow scintigraphy using 99mTc monoclonal antigranulocyte antibodies in complement to bone scintigraphy in detecting bone metastases from primary breast cancer

This prospective study evaluates bone marrow scintigraphy (BMS) in detecting bone metastases from primary breast cancer when performed in complement to conventional bone scan (BS). Sixty women predominantly with low-stage disease underwent BS followed by BMS within 1-35 days using BW250/183 antigranulocyte antibodies. A receiver operating characteristic (ROC) analysis was performed to compare BS to BS+BMS on a patient-by-patient basis using a 'gold standard' composed of subsequent computed tomography, magnetic resonance imaging, X-ray or BS examinations and at least a 12 month follow-up. Metastases were present in eight out of 60 patients (13%). Specificity was improved by BS+BMS compared to BS alone (90%, 65%) as well as positive predictive value (62%, 27%), accuracy (87%, 72%), positive (10.4, 2.4) and negative (0.20, 0.00) likelihood ratios. Sensitivity (100%, 88%) and negative predictive value (100%, 97%) were similar for BMS+BS and BS alone. As a result of BMS, clinical management was modified in 15 patients (25%). In conclusion, BMS supplements BS by improving specificity, positive predictive value and accuracy in detecting breast cancer bone metastases. The ROC curves show improved specificity for BS+BMS at the same sensitivity compared to BS alone. Consequently, BMS may be useful in low-stage subjects with positive or equivocal BS for metastases.     

Comprehensive imaging of tumor recurrence in breast cancer patients using whole-body MRI at 1.5 and 3 T compared to FDG-PET-CT

PURPOSE: To compare the diagnostic accuracy for the detection of tumor recurrence in breast cancer patients using whole-body-MRI (WB-MRI) at 1.5 or 3T compared to FDG-PET-CT. MATERIALS AND METHODS: Thirty-three female patients with breast cancer and suspicion of recurrence underwent FDG-PET-CT and WB-MRI. Coronal T1w-TSE- and STIR-sequences, HASTE-imaging of the lungs, contrast-enhanced T1w- and T2w-TSE-sequences of the liver, brain and abdomen were performed, using a WB-MRI-scanner at 1.5 (n=23) or 3T (n=10). Presence of local recurrence, lymph node involvement and distant metastatic disease was assessed using clinical and radiological follow-up as a standard of reference. RESULTS: Tumor recurrence was found in 20 of 33 patients. Overall 186 malignant foci were detected with WB-MRI and PET-CT. Both modalities revealed two recurrent tumors of the breast. PET-CT detected more lymph node metastases (n=21) than WB-MRI (n=16). WB-MRI was more precise in the detection of distant metastases (n=154 versus n=147). Sensitivity was 93% (172/186) and 91% (170/186) for WB-MRI and PET-CT, specificity was 86% (66/77) and 90% (69/77), respectively. Examination times for WB-MRI at 1.5 and 3T were 51 and 43 min, respectively, examination time for PET-CT was 103 min. CONCLUSION: WB-MRI and PET-CT are useful for the detection of tumor recurrence in the follow-up of breast cancer. WB-MRI is highly sensitive to distant metastatic disease. PET-CT is more sensitive in detecting lymph node involvement. Tumor screening with WB-MRI is feasible at 1.5 and 3T, scan time is further reduced at 3T with identical resolution.     

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.     

Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these, 21 (19% of total group) had one or several bone metastases confirmed by biopsy (n = 8) or radiographic techniques (n = 13). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC. Received 10 March and in revised form 7 May 1998     

Whole body MRI for detecting metastatic bone tumor: comparison with bone scintigrams.

PURPOSE: To compare the effectiveness of whole body MRI (WB-MRI [magnetic resonance imaging]) and bone scintigram (BS) at detecting bone metastasis. MATERIALS AND METHODS: WB-MRI was performed on 16 patients for detecting bone metastasis (6 breast carcinoma, 7 prostatic carcinoma, 1 renal cell carcinoma [RCC], 1 hepatocellular carcinoma [HCC], and 1 primary unknown). BS was also performed in all cases. Patients were placed on a table top extender (Philips Medical Systems). The maximal longitudinal field of view (FOV) was 200 cm. At first, the total spine was imaged in the sagittal plane with a three-station approach for two image sets (fast spin-echo [SE] T1-weighted images [T1WI] and short tau inversion recovery [STIR] images). The whole body was then imaged in the coronal plane with a seven-station approach for two image sets (fast field echo [FFE] T1WI and STIR). Total examination time, including patient positioning, was within 40 min. Three independent radiologists interpreted the imaging data. RESULTS: WB-MRI identified 5 cases of 24 lesions as bone metastasis, while BS identified 3 cases of 25 lesions. Concordance between WB-MRI and BS was seen in 3 cases of 22 lesions (81%). For two cases of 2 lesions, which were identified only with WB-MRI, the lesions were located in the sacrum and thoracic spine. For one case of 3 lesions, which was identified only with BS, the lesions were located in the skull and rib. CONCLUSION: WB-MRI was an excellent method for screening bone metastasis, especially the vertebral body.