^18F-FDG PET／CT诊断恶性肿瘤骨转移的应用价值

目的评价^18F-脱氧葡萄糖（FDG）PET／CT检测恶性肿瘤骨转移的应用价值。方法回顾性分析经^18F-FDG PET／CT诊断的689例恶性肿瘤患者的资料，按颈椎、胸椎、腰椎、骶尾椎、骨盆、肩胛骨和锁骨、长骨、胸骨、肋骨及颅骨将机体骨骼分为10个区域，记录每个区域的骨转移情况。根据同机CT进一步区分转移灶的病变性质（破骨性或成骨性），比较同机CT、^18F-FDG PET及^18F-FDG PET／CT诊断骨转移的灵敏度、特异性及准确性。计算阳性病灶的最大标准摄取值（SUVmax）。患者不同性别间年龄差异采用χ^2检验，诊断率的比较采用MeNemar检验。结果共有91例患者442个区域被确定有骨转移，PET／CT诊断骨转移患者的灵敏度、特异性和准确性分别为94．5％（86／91）、97．8％（585／598）和97．4％（671／689），高于同机CT的79．1％（72／91），91．8％（549／598）和90．1％（621／689）（χ^2=20．049，148．890，168．792，P：0．000）；PET／CT诊断病灶骨转移的灵敏度、特异性和准确性分别为95．0％（420／442），97．2％（455／468）和96．2％（875／919），高于同机CT的81．0％（358／442），90．4％（423／468）和85．8％（781／910）（χ^2=98．673，125．691，220．375，P=0．000）。同机CT共诊断出99个成骨性和197个破骨性病变。PET真阳性病灶SUVmax为6．7±3．0，假阳性病灶SUVmax为3．7±1．3（χ^2=463．120，P=0．000）；成骨性病变SUVmax为4．9±2．0，破骨性病变SUVmax为7．4±3．1（χ^2=327．175，P：0．000）。结论同机CT和^18F-FDG PET图像的结合提高了PET／CT诊断恶性肿瘤骨转移的能力；同机CT能精确定位病变，并可区分转移病灶的成骨或破骨性质。

Bone metastasis in malignancy: the diagnostic role of 18F-FDG PET/CT

Objective The aim of this retrospective study was to understand the role of18F-fluorodeoxyglueose (FDG) PET/CT in detecting bone metastasis in various cancers. Methods Six hundred and eighty-nine cancer patients who had 18 F-FDG PET/CT were included. The diagnosis of bone metastasis was based on matched findings of FDG-avid lesion on PET and characteristic morphological changes on CT. The sensitivity, specificity and accuracy of CT, and PET/CT were calculated and the results were statistically analyzed ( McNemar test). Results Ninety-one patients with 442 regions were diagnosed to have bone me-tastases. On patient base analysis, the sensitivity, specificity, and accuracy of hybrid CT for detecting bone metastases were 79.1% ( 72/91 ) , 91.8 % ( 549/598 ) , 90.1% ( 621/689 ) and were 94.5% (86/91), 97.8% (585/598), 97.4% (671/689) for PET/CT (X2=20.049,148.890,168.792, all P=0.000). On lesion base analysis, the sensitivity, specificity, and accuracy of hybrid CT for detecting bone metastases were 81.0% (358/442), 90.4% (423/468), 85.8% (781/910) and were 95.0% (420/442), 97.2% (455/468), 96.2% (875/910) for PET/CT (X2=98.673,125.691, 220.375, all P= 0.000). The maximum standardized uptake value ( SUVmax) of PET true positive and false positive lesions were 6.7±3.0 and 3.7±1.3 respectively (X2 =463.120, P =0.000). The SUVmaxof osteoblastic and osteolytic lesions were4.9±2.0 and7.4±3.1, respectively (X2 =327. 175, P=0.000). Conclusions It is worth noting that 18F-FDG PET/CT is a novel tool to evaluate bone metastasis and its performances due to the combina-tion of PET and CT. Hybrid CT has a high value in providing precise location of the metastatic sites.