18F-FDG PET与99Tcm-MDP骨扫描诊断肿瘤骨转移的比较分析

目的:探讨18F-FDG PET显像对于肿瘤骨转移的诊断价值,并与99Tcm-MDP骨显像进行对比分析。方法:97例肿瘤及疑诊为肿瘤的患者在30天内先后行18F-FDG PET-CT及99Tcm-MDP骨扫描,对比分析两者的显像结果。结果:97例中经临床和病理确诊基于病例分析,为骨转移63例,62例18F-FDG PET显像阳性,1例假阴性;99Tcm-MDP骨显像阳性49例,假阴性14例,两者敏感度分别为98.4%和77.8%,差异有显著性意义(P<0.05);34例为阴性患者,其中PET显像阴性29例、假阳性5例,骨显像阴性21例、假阳性13例,两者的特异度为85.3%和61.8%(P>0.05),符合率为93.8%和72.2%(P<0.05)。基于病灶分析,97例中共分析1261个骨骼区,骨转移存在于226个骨骼区,剔除不能定性的14个区,18F-FDG PET显像阳性222个区,假阴性4个区;而骨扫描显像阳性154个区,假阴性72个区;两者的敏感度分别为98.7%和68.1%,差异有显著性意义(P<0.05)。1021个阴性区,其中18F-FDGPET显像为阴性1010个区,假阳性11个区;骨扫描显像阴性1001个区,假阳性20个区;两者特异度分别为98.9%和98.0%,差异无统计学意义(P>0.05)。18F-FDG PET的诊断符合率为98.8%,骨显像为92.6%,两者差异有显著性意义(P<0.05)。以CT表现分组,溶骨性病灶和CT上无明显异常改变病灶的FDG PET和骨扫描的检出率分别为99.4%和72.6%及81.5%和40.7%,差异有显著性意义(P<0.05)。结论:18F-FDG PET诊断敏感度及准确性均高于骨扫描对溶骨病灶和CT上无明显改变病灶的检出优于骨扫描。

Comparison of the Value of 18F-FDG PET and 99Tcm-MDP Bone Scan in the Detection of Bone Metastases

Objective:To evaluate the diagnostic value of 18F-2-deoxyglucose (18F-FDG) PET imaging in the detection of bone metastases and to compare with that of 99Tcm-MDP bone scan.Methods:18F-FDG PET/ CT and 99Tcm-MDP bone scan were performed in 97 patients having or being suspected malignant tumor.The interval of these 2 examinations was within 30 days.The results of the above-mentioned examinations were compared and analyzed.Results:Of the 97 patients,63 patients had clinical or pathology diagnosed bone metastases.Based on case to case analyses,18F-FDG-PET showed 62 patients with positive diagnosis,and 1 patient was false negative;99Tcm-MDP showed 49 patients with positive diagnosis and 14 patients were false negative.The sensitivity was 98.4% vs 77.8%,showing significant statistical difference (P<0.05).Of the 34 patients without bone metastases,18F-FDG-PET showed 29 patients with true negative and 5 patients with false positive results,while 99Tcm-MDP had 21 true negative and 13 false positive cases.The specificity was 93.8% vs 72.2% (P<0.05) and the accuracy was 93.8% vs 72.2% (P<0.05) respectively.Based on focal lesion to lesion analysis,altogether there were 1261 bone regions in these 97 patients (the skeletal system was divided into 13 regions),with 226 regions having metastases,14 regions were excluded due to indeterminate final diagnosis.Of these,18F-FDG-PET found 222 regions showing true positive diagnosis and 4 regions showing false negative;99Tcm-MDP showed 154 regions had at least one positive lesion,72 regions showed false negative.The sensitivity was 98.7% vs 68.1% (P<0.05),with significant statistical difference as well.Of the 1021 regions did not have skeleton metastases,18F-FDG-PET showed 1010 true negative and 11 false positive regions,while 99Tcm-MDP showed 1001 true negative and 20 false positive regions.The specificity and accuracy were 98.9% vs 98.0% (P>0.05) and 98.8% vs 92.6% (P<0.05) respectively.According to CT features,the detection rate of bone metastases with CT osteolytic lesion and no CT abnormality by 18F-FDG-PET and 99Tcm-MDP were 99.4% vs 72.6% and 81.5% vs 40.7% respectively,with significant statistical differences (P<0.05).Conclusion:18F-FDG PET has higher sensitivity and accuracy than 99Tcm-MDP bone scan,no matter based on case or based on focal lesion analysis.Furthermore,for osteolytic and no abnormality CT lesions,the detection rate of 18F-FDG PET was superior than bone scan.