Na18F用于肿瘤骨转移病灶显像及其诊断效能

目的介绍骨转移瘤的Na18F PET/CT显像,并比较其与Na18F PET和99Tcm-亚甲基二膦酸盐(MDP)ECT显像对骨转移病灶的诊断效能。方法对临床15例多发性骨转移瘤患者,分别行Na18F PET/CT、Na18F PET和99Tcm-MDP ECT显像,将肉眼可见的骨骼热区记为转移、无法定性和非转移病灶,通过临床随访最终定性诊断为转移病灶、非转移病灶,比较3种检查方法探测骨转移灶的灵敏度、特异度和准确率。结果 Na18F PET/CT和Na18F PET均检出全部168处病灶,99Tcm-MDP ECT探测到全部病灶的64.88%(109/168)。当无法定性的病灶被计入转移病灶时,Na18F PET/CT、Na18F PET和99Tcm-MDP ECT的灵敏度、特异度分别为100%、100%;99.17%、72.92%;66.67%、39.58%。前两者与后者之间差异均有统计学意义(χ2=17.8、χ2=8.2、χ2=18.0、χ2=25.4,P均<0.05)。当无法定性的病灶被计入非转移病灶时,Na18F PET/CT、Na18F PET和99Tcm-MDP ECT的灵敏度、特异度分别为100%、93.75%;93.33%、79.17%;57.50%、81.25%。PET/CT、PET较ECT灵敏度差异均有统计学意义(χ2=26.1、χ2=22.5,P均<0.05),而特异度差异均无统计学意义(χ2=4.8、χ2=0.44,P均>0.05)。结论 Na18F PET/CT用于骨转移瘤显像具有高灵敏度、高特异度兼备的优势。

The diagnostic value of Na18F PET/CT imaging in bone metastasis

Objective To evaluate the diagnostic value of 18F-fluoride（Na18F） PET/CT in bone metastasis and compare with the Na18F PET and 99Tcm-methylene diphosphonate（MDP） ECT.Methods In the prospective study,Na18F PET/CT,Na18F PET and 99Tcm-MDP ECT were performed in 15 patients with multiple metastatic lesions.Lesions were interpreted as normal,equivocal and malignant according to the clinical follow-up results.Results 168 lesions with increased uptake of Na18F were assessed as malignant（n=120,71.43%）,benign（n=48,28.57%）.99Tcm-MDP ECT identified 64.88% lesions（109/168） and 35.12% lesions（59/168） were overlooked with normal appearance.When equivocal results were considered as positive for malignancy,the sensitivity and specificity of Na18F PET/CT,Na18F PET and 99Tcm-MDP ECT were 100%,100%;99.17%,72.92%;66.67%,39.58% respectively.The statistical differences between the former 2 and the latter were significant（χ2=17.8,χ2=8.2,χ2=18.0,χ2=25.4,P0.05）.When equivocal results were considered as negative for malignancy,the sensitivity and specificity of Na18F PET/CT,Na18F PET and 99Tcm-MDP ECT were 100%,93.75%;93.33%,79.17%;57.50%,81.25% respectively.There were significant differences in sensitivity between Na18F PET/CT,Na18F PET and 99Tcm-MDP ECT（χ2=26.1,χ2=22.5,P0.05）,while there were no significant differences in specificity among them（χ2=4.8,χ2=0.44,P0.05）.Conclusion Na18F PET/CT is a higher sensitive and specific modality for detection of bone metastases.