骨转移瘤18F—FDGPET／CT影像学表现分析

目的分析骨转移瘤的18F-脱氧葡萄糖（FDG）PET／CT影像学表现。方法140例18F—FDGPET／CT检查病例，按病灶的4种CT形态（成骨改变、溶骨改变、混合改变及无改变）分组，探讨肿瘤骨转移灶代谢表现与形态表现之间的关系，进一步治疗情况与转移灶代谢表现的关系。采用SPSS10．0软件，行Mann—Whitney检验及x2检验。结果140例患者分未治疗组78例（55．7％），治疗（化疗及内分泌）组62例（44．3％）。共检出病灶1658个，CT示成骨病灶415个（25．0％），溶骨病灶567个（34．2％），混合病灶177个（10．7％），无改变病灶499个（30．1％）。对未治疗组1045个病灶平均标准摄取值（SUVmax。）行Mann—Whitney检验，混合病灶、溶骨病灶SUVmax高于成骨病灶、无改变病灶（SUVmax。中位值分别为5．7，5．2，4．8及4．6，Z=-4．680，-6．067，-2．237，-4．635，P均〈0．05）；治疗组与未治疗组行，检验，未治疗组以溶骨性改变（39．6％）为多，治疗组以成骨性改变（35．9％）为多，组间病灶组成明显不同（x2=67．8，P〈0．05），治疗组代谢水平明显低于未治疗组（SUVmax中位值分别为4．9及4．6，Z=-4．315，P〈0．05）。结论骨转移病灶形态表现不同，其代谢表现差异明显，溶骨病灶的SUVmax。明显大于无溶骨病灶；化疗及内分泌治疗能通过对病灶转归的改变影响病灶形态及相应代谢表现。

Investigation of imaging characters of bone metastases on ~(18)F-FDG PET/CT

Objective To investigate the imaging characters of bone metastases on ~(18)F-fluorodeox-yglucose (FDG) PET/CT. Methods ~(18)F-FDG PET/CT studies in 140 patients had been retrospectively reviewed. The metastatic bone lesions were categorized into four groups: osteoblastic, osteolytic, mixed-type, or no change in bone density based on CT morphological features, to evaluate their relationships with the degree of ~(18)F-FDG metabolism. The correlations of the therapeutic conditions with CT morphological fea-tures and with the degree of ~(18)F-FDG metabolism were also respectively analyzed. The Mann-Whitney test and χ~2-test were performed by SPSS 10.0. Results In 140 patients, 78(55.7% ) patients were untreated and 62 (44.3%) patients had been treated by chemotherapy or hormonal therapy before this study. A total of 1658 metastatic bone lesions were found in 140 patients, including 415 osteoblastic lesions (25.0%),567 osteolytic lesions (34.2%), 177 mixed-type lesions (10.7%) and 499 lesions with normal CT ap-pearance (30.1%). Osteolytic and mixed-type lesions showed much higher ~(18)F-FDG uptake on PET/CT than osteoblastic and normal CT lesions in 1045 lesions of 78 untreated patients in terms of mean standardized uptake value (SUV_(mean)). The median of SUV_(mean) of the mixed-type, osteolytic, osteoblastic and normal CT groups was 5.7, 5.2, 4.8 and 4.6, respectively (Z=-4.680, -6.067, -2.237, -4.635, all P < 0.05). Comparing the treated and untreated groups, there were more osteolytic lesions in untreated group (39.6%) ; while more osteoblastic lesions in treated group (35.9%). The CT morphological features of the two groups showed significant difference (χ~2 = 67.8, P < 0.05). The median of SUV_(mean) of the untreat-ed group (4.9) was higher than that (4.6) of the treated group (z=-4.315, P<0.05). Conclusions There is significant metabolic difference among bone metastases with different CT morphological features.The lesions with osteolytic changes, whether purely osteolytic or mixed-type, have higher SUV_(mean) than os-teoblastic or normal CT lesions. Chemotherapy and hormonal therapy could change the metabolic features on PET and the morphologic features on CT.