SPECT/CT骨显像对脊柱单发阳性病灶的应用价值

目的评价99Tcm-亚甲基二膦酸盐（MDP）SPECT/CT骨断层显像对脊柱单发阳性病灶良恶性鉴别诊断的价值。方法对921例99Tcm-MDP全身骨显像提示脊柱单发阳性病灶的患者,行SPECT/CT局部断层显像,得到局部SPECT、CT及融合影像。阅片由两位有经验的核医学医师分别独立进行,所有病灶均以病理学结果及6个月以上的影像随访为＂金标准＂。结果在921例患者中,161例诊断为肿瘤骨转移（17.5%）,4例诊断为原发骨肿瘤（0.4%）,2例诊断为骨髓瘤（0.2%）,5例诊断为骨结核（0.5%）,689例诊断为良性病变（74.8%）,59例诊断为外伤致椎体压缩性骨折（6.4%）,1例诊断为许莫氏结节（0.1%）。肿瘤骨转移病例共161例,其中颈椎9例（5.6%）,胸椎46例（28.6%）,腰椎82例（50.9%）,骶椎24例（14.9%）。按部位分类,颈椎病变共30例,肿瘤骨转移9例（30%）;胸椎病变共224例,肿瘤骨转移46例（20.5%）;腰椎病变共606例,肿瘤骨转移82例（13.5%）;骶椎病变共61例,肿瘤骨转移24例（39.3%）。结论99Tcm-MDP SPECT/CT同机融合骨显像,对常规全身骨显像单发阳性病灶提供了准确的定位,同时显示了该病灶的形态及周围软组织影像特征,显著降低了骨显像中椎体单发阳性病灶的假阳性率,在脊柱单发阳性病灶的鉴别诊断中较常规全身骨显像具有更高的临床诊断价值。

SPECT/CT Bone Scan for Differential Diagnosis of Spinal Single Positive Lesions

Objective To assess the clinical value of SPECT/CT bone scan for differential diagnosis of spinal single positive lesions. Methods A total of 921 patients with bone diseases （412 males, 509 females, age 68.82 ± 12.07 y） were included in this study. 99Tcm-MDP whole-body planar bone scan and regional SPECT/CT tomography were conducted. Results Among the 921 patients, 161 cases were diagnosed as metastatic tumor of bone （17.5%）, 4 cases were diagnosed as primary bone tumors （0.4%）, 2 cases were diagnosed as myeloma （0.2%）, 5 cases were diagnosed as bone tuberculosis （0.5%）, 689 cases were diagnosed as benign lesions （74.8%）, 59 cases were diagnosed as traumatic osteoporotic vertebral compression fractures （6.4%）, 1 cases was diagnosed as Schmorl＇s nodes （0.1%）. A total of 161 patients were found with metastasis tumor of bone, including 9 cases （5.6%） of cervical, thoracic in 46 cases （28.6%）, 82 cases （50.9%） of lumbar and sacral vertebra in 24 cases （ 14.9% ）. According to site classification, a total of 30 cases of cervical lesions, 9 cases with bone metastases （30%） ; a total of 224 cases of thoracic vertebral lesions, 46 cases with bone metastases （ 20. 5% ） ; lumbar lesions were 606 cases, 82 cases with bone metastases, （ 13.5% ） ; sacral vertebral lesions in 61 cases, 24 cases with bone metastases （39.3%）. Conclusion SPECT/CT tomography provides accurate positioning of single positive lesions detected in the whole- body bone scan, and also shows the morphology and the imaging features of soft tissue around this lesion. It might significantly reduce the false positive rate of vertebral bone scan in single lesion, and has important clinical value in the differential diagnosis of single spinal lesions.