SPECT/CT骨定量SUVmax分析在老年前列腺癌骨转移中的鉴别诊断价值

  目的  探讨SPECT/CT骨定量分析获得最大标准摄取值（SUV_max）对老年前列腺癌骨转移的鉴别诊断价值。  方法  回顾性分析2019年1~12月我院158例确诊前列腺癌患者的99mTc-MDP SPECT/CT骨显像资料。对异常放射性浓聚灶及182个正常椎体行SPECT/CT检查及骨定量分析，比较良恶性病灶与正常椎体之间SUV_max的差异性。选取2019年1~4月46例患者的144个异常浓聚灶，通过绘制ROC曲线得到SUV_max的最佳临界值；选取2019年5~12月293个异常浓聚灶，使用SUV_max的最佳临界值比较SPECT/CT骨定量分析与常规SPECT/CT的诊断效能。  结果  以病理或随访作为判断标准，所有老年前列腺癌患者共437个异常浓聚灶（恶性254个，良性183个），恶性病灶的SUV_max明显高于良性病灶（43.93±19.09 vs 15.26±6.81，P < 0.01）和正常椎体（6.54±1.19，P < 0.01）。通过ROC曲线得到SUV_max≥19.2为诊断恶性病灶的最佳临界值，常规SPECT/CT与SPECT/CT骨定量诊断的准确度、敏感度、特异性、阳性预测率、阴性预测率分别为81.6%和94.5%、93.0%和96.5%、65.2%和91.7%、79.2%和94.3%、86.8%和94.9%，SPECT/CT骨定量诊断的准确度、特异性、阳性预测率和阴性预测率均明显高于常规SPECT/CT。  结论  SPECT/CT骨定量分析在老年前列腺癌骨转移的鉴别诊断中具有重要临床应用价值，具有临床应用的潜力。 

Differential diagnosis value of SPECT/CT bone quantitative SUVmax analysis in the bone metastases of elderly prostate cancer patients

  Objective  To investigate the differential diagnosis value of SPECT/CT bone quantitative analysis in bone metastases of elderly prostate cancer patients.  Methods  From January to December in 2019, 158 patients with elderly prostate cancer who underwent whole body bone scan were enrolled. SPECT/CT bone quantitative analysis were preformed on abnormal radioactive concentration lesions and 182 normal vertebral. The differences of SUV_max among the benign, malignant, and normal vertebral were compared. A total of 144 lesions of 46 patients from January to April in 2019 are plotted ROC curve to obtain cut-off values of SUV_max. A total of 293 lesions from May to December 2019 were selected to compare the diagnostic efficacy between SPECT/CT bone quantitative analysis and conventional SPECT/CT.  Results  A total of 437 lesions (254 malignants/183 benigns) were determined with pathology or follow-up results. The SUV_max of malignant lesions was significantly higher than benign lesions (43.93±19.09 vs 15.26±6.81, P < 0.01) and normal vertebral (6.54±1.19, P < 0.01). Using the best cut-off value of SUV_max≥19.2 as the diagnostic criterion, the accuracy, sensitivity, specificity, positive prediction rate, and negative prediction rate of conventional SPECT/CT and SPECT/CT bone quantitative analysis were 81.6% and 94.5%, 93.0% and 96.5%, 65.2% and 91.7%, 79.2% and 94.3%, 86.8% and 94.9%, respectively. The accuracy, specificity, positive prediction rate and negative prediction rate of SPECT/CT bone quantitative diagnosis were significantly higher than conventional SPECT/CT.  Conclusion  SPECT/CT bone quantitative analysis has important differential diagnosis value in bone metastases of elderly prostate cancer, and it has the potential for clinical application.