^18F-氟化钠PET和PET-CT诊断肺癌骨转移的对比研究

目的对比研究^18F-氟化钠（^18F-NaF）PET和PET-CT对肺癌骨转移诊断的准确性。方法34例初始诊断为肺癌的患者接受^18F-NaFPET-CT检查，对PET和PET-CT图像分别进行解释，发现的病变分为恶性、良性和不确定三种。骨转移的综合评价方法包括MRI（34例）、^18F-氟脱氧葡糖糖PET-CT（4例）、组织学活检（2例）和临床随访（6例）。结果按患者水平分析时，34例患者中的11例（32％）发生骨转移，其中，^18F-NaFPET—CT准确诊断所有患者的骨转移，无假阳性和假阴性，而^18F-NaFPET诊断真阳性8例、3例不能确定，^18F-NaFPET确诊的8例骨转移患者中的4例PET没有显示全部转移病变（假阴性和不确定病变）；按病变水平分析时，118个病变获得最终诊断，其中转移病变47个、良性病变71个，其中，^18F-NaFPET诊断真阳性27个、真阴性64个、不确定病变24个、假阴性1个、假阳性2个，而^18F-NaFPET-CT诊断真阳性46个、假阴性1个、真阴性71个。按患者水平分析，将不确定病变归为恶性时，^18F-NaFPET-CT的特异性高于^18F-NaFPET（100％vs78％，χ2=10．78，P〈0．05），二者的灵敏度均为100％；将不确定病变归为良性时，^18F-NaFPET-CT诊断骨转移的灵敏度显著高于^18F-NaFPET（100％vs73％，r=6．41，P〈0．01），二者特异度差异无显著性（100％vs96％，χ^2=2．03，P〉0．05）；按病变水平分析时，得到与患者水平分析相似结果。结论 ^18F-NaFPET-CT诊断肺癌骨转移的准确性优于^18F-NaFPET，PET—CT中的低剂量CT可进一步提高良、恶性病变的鉴别能力。

Comparison between ^18F-NaF PET and PET-CT to detect bone metastases in patients with lung cancer

Objective To evaluate the effect of lSF-sodium fluoride （^18F-NaF） PET-CT in the detection of bone metastases in patients with lung cancer. Methods Thirty-four patients with newly diagnosed lung cancer were performed with ^18F-NaF PET-CT. ISF-NaF PET and ^18F-NaF PET-CT were interpreted separately. Lesions were categorized as malignant, benign or inconclusive. A panel of reference methods was used, including MRI （34 patients） , ^18F-fluorodeoxyglucose PET-CT （4 patients） , histopathology （2 patients）, or clinical follow-up of at least 6 months （6 patients）. Results In patient-based analysis, 11 of 34 patients had bone metastases. ^18F-NaF PET-CT correctly diagnosed all 11 patients with bone metastases, ^18F-NaF PET only correctly detected 8 of them. ^18F-NaF PET-CT had no false and inconclusive diagnosis. In lesion-based analysis, 118 lesions were assessed which had final diagnosis （47 metastases, 71 benign lesions）.^18F-NaF PET-CT was correct in 46 metastatic lesions and 71 benign lesions, but false-negative in lesion. ^18F-NaF PET was correct in 27 metastatic lesions and 64 benign lesions, but wrong in 3 lesions （2 benign lesions, 1 metastatic lesions）, and equivocal in 24 lesions. Based on the corresponding appearance on low-dose CT, 46 of 47 lesions were categorized metastases （31 presented as sites of increased uptake with corresponding lytic or sclerotic changes, and other 15 metastases show normal or non-specific appearing bone）, only 1 sclerotic metastasis was judged benign. All 71 benign lesions have a benign appearance on low-dose CT. In patientbased analysis, categorizing equivocal and malignant interpretation as suggestive for malignancy, the lSF-NaF PET-CT was more specific than ^18F-NaF PET（100% vs 78%, χ2=-10.78, P〈0.05）, the sensitivity was 100% for each other. Categorizing equivocal and benign as benignity, the ^18F- PET-CT was more sensitive than ^18F-NaF PET （100% vs 73%, X2=6.41, P〈0.001）, the specificity between them was not significantly （100% v