分化型甲状腺癌骨转移：18F-FDG SPECT显像能否取代全身骨显像

目的：比较18F-脱氧葡萄糖（FDG）SPECT显像和全身骨显像对于分化性甲状腺癌（DTC）骨转移灶检测能力的区别。方法：回顾性分析2005年1月～2009年1月期间接受131I治疗的DTC骨转移患者17例（男8,女9）,年龄（46～82）岁。8例乳头状腺癌,9例滤泡状腺癌。7例单纯骨转移,10例合并淋巴结和/或肺转移。所有患者在接受大剂量131I治疗转移灶前2d～10d均行18F-FDG SPECT显像和99mTc-MDP全身显像。使用SPSS11.0软件对组别之间比较行χ2检验。结果：17例患者共发现70个骨转移区。18F-FDG SPECT显像的灵敏度71.34%（50/70）高于全身骨显像62.86%（44/70）,但两者差异无统计学意义（t=1.17,P〉0.05）。特异度和准确度18F-FDG SPECT显像97.76%（131/134）和88.73%（181/204）均高于全身骨显像91.04%（122/134）和81.37%（166/204）,且差异都具有统计学意义（t=5.72,P〈0.05和t=4.34,P〈0.05）。结论：对于DTC骨转移的检测,18F-FDG SPECT显像的灵敏度与全身骨显像相仿,而特异度和准确度高于全身骨显像。但是,对于小部分成骨性反应为主的DTC骨转移灶,全身骨显像更为灵敏。所以,18F-FDG SPECT显像不能完全取代全身骨显像,全身骨显像对于检测DTC骨转移仍然具有临床价值,可作为18F-FDG SPECT显像的一种补充。

Bone Metastases of Differentiated Thyroid Carcinoma: Could 99mTc-bone Scintigraphy be Substituted with Whole-body 18F-FDG SPECT

Objective The purpose of this study was to compare 18F-FDG SPECT and 99mTc-bone scintigraphy in the detection of bone metastases of DTC.Methods In this retrospective study,17 bone metastastic DTC patients treated by radioiodine from January 2005to January 2009 were reviewed.8 males and 9 females,age range 46~82.8 had papillary carcinoma and 9 had follicular carcinoma.7 were proved clinically or pathologically to have bone metastases only and 10 have bone metastases with lymph node and/or pulmonary metastases as well.All the patients underwent both 18F-FDG SPECT and 99mTc-bone scintigraphy from 2to10 days before the radioiodine therapy to detect bone metastases.Statistical analysis was performed with SPSS11.0,and Chi-square test was used.Results There were overall 70 bone metastastic lesions confirmed in 17 patients.In evaluating the detection of bone metastases,18F-FDG SPECT showed 71.34%(50/70)sensitivity,97.76%(131/134) specificity and 88.73%(181/204)accuracy,compared with 62.86%(44/70),91.04%(122/134) and 81.37%(166/204),respectively,for bone scintigraphy.The sensitivity of 18F-FDG SPECT was similar to that of bone scintigraphy,this difference was not statistically significant(t=1.17,P>0.05).While the specificity and accuracy of 18F-FDG SPECT were statistically significantly higher than those of bone scintigraphy(t=5.72,P<0.05)and(t=4.34,P<0.05)individually.Conclusion This study suggested that 18F-FDG SPECT has a higher specificity and a better accuracy than that of bone scintigraphy to detect bone metastases in patients with DTC.But bone scintigraphy was superior to 18F-FDG SPECT in the detection of osteoblastic lesions.Thus bone scintigraphy should play a complementary role in detecting bone metastases with 18F-FDG SPECT and could not be replaced by it.