PACS影像系统在单发骨骼病变诊断中的应用价值

目的 评价 PACS 影像系统在骨骼病变定性诊断中的价值。方法 6 127 例骨扫描患者中发现骨单发核素异常分布 141 例,对核素骨显像异常病变部位进行 CT 扫描。核素骨显像、CT 分别做出诊断及在 PACS 影像系统中二者联合做出诊断,并与随访结果和病理对照。结果 141 例骨单发核素异常分布患者,经随访和病理证实有 75 例为骨转移。核素骨显像、CT 与利用 PACS 影像系统二者联合诊断骨转移瘤的灵敏度分别为 93.33%（70/75）、85.33%（64/75）、100%（75/75）;特异性为 56.06%（37/66）、98.48%（65/66）、95.45%（63/66）;准确率为 75.89%（107/141）、91.49%（129/141）、97.87%（138/141）;阳性预测值为 70.71%（70/99）、98.46%（64/65）、92.15%（75/78）;阴性预测值为88.10%（37/42）、85.53%（65/76）、100%（63/63）。核素骨显像灵敏度优于CT;CT 诊断特异度、准确率及阳性预测值优于核素骨显像（P<0.05）。二者联合诊断特异度、准确率及阳性预测值明显优于单纯核素骨显像（P<0.05）,灵敏度和阴性预测值明显优于单纯 CT（P<0.05）。结论 核素骨显像灵敏度高,对 CT 检查有“导航”作用; CT 检查有助于区分核素骨显像单发病变的良恶性;二者联合诊断可明显提高单发骨转移瘤的诊断准确率。

Application value of PACS Image system in the diagnosis of single bone lesions

Objective To explore the evaluation of PACS image system in the qualitative diagnosis of single bone lesions. Methods 141 patients with single bone lesion were selected from 6 127 patients who were performed radionuclide bone imaging, underwent CT scan immediately after bone scan, radionuclide bone imaging diagnosis, CT diagnosis respectively, and examined with the combination diagnosis in PACS image system, The final diagnosis was proved by clinical follow-up or pathology. Results Seventy-five patients in 141 cases were diagnosed bone metastases. The diagnostic sensitivity of radionuclide bone imaging, CT and the combination diagnosis in PACS image system were 93.33%(70/75), 85.33%(64/75) and 100%(75/75) respectively. The specifcities were 56.06%(37/66), 98.48%(65/66) and 95.45%(63/66) respectively. The accuracy rates were 75.89%(107/141), 91.49%(129/141) and 97.87%(138/141) respectively. The positive predictive values were 70.71%(70/99), 98.46%(64/65) and 92.15%(75/78) respectively. The negative predictive values were 88.10%(37/42), 85.53%(65/76) and 100%(63/63) respectively. Radionuclide bone imaging was superior to CT scan, CT scan was superior to bone scan in specificity, accuracy and the positive predictive value(P<0.05). There were significant differences in specificity, accuracy and the positive predictive value between the combination diagnosis in PACS image system and bone scan (P<0.05), and in sensitivity and the negative predictive value between CT combined bone scan in PACS image system and CT alone (P<0.05). Conclusion Radionuclide bone imaging has high sensitivity, it has the "navigation" function for CT scan. CT contributes to distinguishing benign and malignant single bone lesions with bone scan. The combination of CT and bone scan can improve accordance obviously in diagnosis of solitary bone metastasis.