肺癌患者SPECT／CT同机融合显像肋骨单发病灶影像分析

目的分析肺癌患者SPECT／CT同机融合显像肋骨单发病灶的特征和临床诊断之间的相互关系，并评价定位CT在诊断中的作用。方法在SPECT全身骨显像中发现肋骨单发病灶68例肺癌患者加行SPECT／CT同机融合显像，所有病变按位置分为前肋、侧肋、后肋、肋骨与肋软骨交界处四个部位，按病灶形状分为点状和条形两种，并进行分类分析，同时分析SPECT全身骨显像和SPECT／CT同机融合显像方法的诊断效能。结果SPECT全身骨显像肋骨骨折所致单发浓聚灶占52．94％（36／68）；条形病灶中肋骨转移占91．30％（21／23）；肋骨与肋软骨交界处病灶都呈点状，全部为良性病变；后肋病灶中肋骨转移占81,82％（18／22）。SPECT全身骨显像和SPECT／CT同机融合显像诊断单发浓聚灶骨转移敏感度分别为69．23％（18／26），92．31％（24／26），特异度59．52％（25／42），85．71％（36／42），准确度63．24％（43／68），88．24％（60／68），阳性预测值51．43％（18／35），80．00％（24／30），阴性预测值75．76％（25／33），94．74％（36／38）。二者敏感度比较差异有统计学意义（p〈0．05），特异度和准确度比较差异有统计学意义（P〈0．01）。结论肋骨单发病灶良恶性病变具有一定的图像特点，对于鉴别诊断具有十分重要的临床意义，SPECT／CT同机融合显像提高了诊断的准确性。

SPECT/CT fusion imaging analysis of costal single hot spots in patients with lung cancer

Objective To analyze the imaging features and clinical significance of solitary costal hot spots in patient with lung cancer on SPECT/CT fusion imaging and the value of low-dose CT for diagnosis. Methods SPECT/CT scan was performed on 68 patients with lung cancer and costal single hot spots using whole body bone imaging. The sites of lesions were classified into four types： junction between costal cartilage and rib,frontal rib, lateral rib, posterior rib. The shapes of lesions were classified into two forms： punctiform and strip shapes, and were analyzed and classified. The differences of the diagnosis of whole body bone imaging and SPECT/CT scan were analyzed. Results Punctiform spots were mainly due to costal fractures（36/68,52.94% ）. The majority of spots in strip shape were costal metastases （21/23,91.30%）. The lesions of junction between costal cartilage and rib were punctiform shape and benign. Hot spots in posterior ribs were mainly costal metastases （ 18/22,81.82% ）. Sensitivity of diagnosis of the metastatic bone tumor with whole body bone imaging and SPECT/CT in single hot spot of spine and rib was 69.23% （18/26） and 92.31% （ 24/26 ）, specificity 59.52% （ 25/42 ） and 85.71% （ 36/42 ）, accuracy 63.24% （ 43/68 ） and 88.24% （ 60/68 ）, positive predictive value 51.43% （ 18/35 ） and 80.00% （ 24/30 ）, negative predictive value 75.76% （25/33） and 94.74%（ 36/38 ）. SPECT/CT scan had differences with whole body bone imaging in sensitivity （P 〈 0.05 ）,SPECT/CT scan had significant differences with whole body bone imaging in coincidence and specificity （P 〈 0.01 ）. Conclusions Useful imaging features can be obtained from SPECT/CT fusion imaging with single costal hot spots, being helpful to differential diagnosis of benign and malignant lesions SPECT/CT fusion imaging may improve the accuracy to diagnose the rib disease.