SPECT／CT图像融合鉴别诊断疑似骨转移灶良恶性的价值

目的 分析单光子发射型计算机断层扫描/X线计算机断层扫描（SPECT/CT）融合图像对平面骨显像中疑似肿瘤骨转移灶的良恶性鉴别诊断的价值.方法 临床拟排除肿瘤骨转移患者187例,常规99m锝-亚甲基二膦酸盐（99mTc-MDP）全身骨平面显像,若发现疑似骨转移（或不能确定）者,则当即追加相应骨的局部核素SPECT和CT检查,并进行SPECT/CT图像融合分析,鉴别或明确疑似病灶的性质,并对部分病例随访或追加检查验证,统计分析单纯SPECT、CT和SPECT/CT方法的诊断效能.结果 疑似病灶共计340个.SPECT/CT融合图像明确为良性病灶137个（40.3%）,恶性病灶172个（50.6%）,仍可疑者31个（9.1%）,与单纯SPECT、CT诊断比较差异有统计学意义（P＜0.01或P〈0.05）.32例获得有明确诊断结论的随访,其诊断灵敏度、特异性、准确率（符合率）和误诊率分别为93.8%（15/16）、87.5%（14/16）、90.6%（19/32）和9.4%（3/32）.结论 SPECT/CT融合图像分析对疑似肿瘤骨转移灶有较高的鉴别或定性诊断价值,但仍有必要结合其他诊断手段综合分析,以减少误诊和漏诊.

Value of SPECT/CT image fusion analysis in differential diagnosis for benign or malignant lesions of suspected bone metastasis

Objective To explore the value of SPECT/CT image fusion analysis in differential diagnosis for benign or malignant lesions of  suspected bone metastasis. Methods A total of 187  patients to be excluded bone metastasis were selected. The patients firstly underwent conventional planar 99mTc-Methylene diphosphonate (99mTc-MDP) whole body bone imaging at first. For suspected bone metastasis, corresponding local bone radionuclide SPECT and CT were used. SPECT/CT image fusion was carried out to identify lesion quality. Some patients were followed up or received additional examination. The differences of the diagnesis of SPECT, CT, and SPECT/CT were analyzed. Results Among a total of 340 suspected lesions. SPECT/CT image fusion diagnosed 137 (40.3%) benign lesions and 172 (50.6%) malignant lesions. Only 31 (9.1%) lesions were suspected. SPECT/CT had significant differences with single SPECT or CT (P<0.01 or 0.05). In 32 patients with definite diagnose, the diagnostic sensitivity, specificity, accuracy rate, and misdiagnosis rate were 93.8% (15/16), 87.5% (14/16), 90.6% (19/32), and 9.4% (3/32), respectively. Conclusion SPECT/CT image fusion analysis has high value in qualitative or differential diagnosis of suspected bone metastasis. However, comprehensive analysis is still need in order to reduce misdiagnosis.