SPECT/CT骨显像鉴别诊断脊柱良恶性病变的价值

目的：探讨^99Tc^m-亚甲基二膦酸盐（MDP）SPECT/CT骨显像在鉴别脊柱良恶性病变中的价值。方法：84例脊柱骨病患者，行^99Tc^m-MDP SPECT/CT骨显像，同时获得全身骨显像、局部断层骨显像、骨CT图像以及后两者的融合图像。由2名核医学科医生和1名放射科医生共同阅片。4种图像的印象诊断与最后诊断符合者，判定为“符合“；病变性质待定或印象诊断与最后诊断不一致，判定为“不符合“。结果：全身骨显像、局部断层骨显像、骨CT以及融合图像对29例骨转移的诊断符合率分别为51.7％、93.1％、89.7％和100％，对55例良性骨病的诊断符合率分别为32.7％、60.0％、92.7％和94.5％。示SPECT/CT骨显像解决了常规骨显像对阳性病灶精确解剖定位难的问题；明显改善了对骨良性病变的诊断能力，降低了骨显像诊断骨转移的假阳性率；对诊断骨转移的类型，如成骨型、溶骨型和混合型有一定的价值；当断层骨显像与骨CT结果不一致时，两者信息互补，有助于对骨病的正确诊断。结论：SPECT/CT骨显像对鉴别脊柱良恶性病变有良好的应用价值。

Evaluation of using 99Tcm-MDP SPECT/CT for differentiating malignancy from benignancy in spine diseases

ObjectiveTo evaluate the value of SPECT/CT in differentiating malignancy from benignancy in spine diseases. MethodsThere were 84(male 39, female 45, mean age 64 yrs) patients underwent bone scanning using 99Tcm-methylene diphosphonate (MDP) and SPECT/CT. The study patients were divided into two groups, group of metastasis(group M, n=29) and group of benign diseases(group B, n=55). Three hours after 99Tcm-MDP intravenous injection, whole body bone scan, bone SPECT, and X-CT were performed. ResultsThe diagnostic accuracy by four modalities in group M, which were whole body bone scan, bone SPECT, bone CT and fusion imaging, was 51.7%, 93.1%, 89.7% and 100% ; in group B was 32.7%, 60.0%, 92.7% and 94.5%, respectively. ConclusionsSPECT/CT using 99Tcm-MDP is clinically valuable in differentiating malignancy from benignancy in spine diseases. First of all is further resolving the problem in conventional bone scan on anatomical localization of the positive foci on bone. The second is reducing the false positive rate and increasing the specificity. The third is increasing the ability to identify different lesion patterns, e.g. osteoblastic, osteolytic, or mixed lesions. Finally, while the results of bone scan and CT were discordant, the complementary informations from both modalities can be used to obtain the accurate diagnosis.