SPECT/CT融合显像在肿瘤患者骨盆病变中的诊断价值

目的 评价99Tcm-亚甲基二膦酸盐（MDP） SPECT/CT融合显像对肿瘤患者骨盆转移病灶的诊断价值。 方法 回顾性分析2018年8至12月于四川省肿瘤医院经组织病理学检查确诊为恶性肿瘤且临床疑似有骨转移的148例患者的临床资料，其中男性77例、女性71例，年龄29~86（48.8±14.5）岁。将患者分为原发盆腔肿瘤组（63例）和非原发盆腔肿瘤组（85例）。所有患者在首次行SPECT全身平面骨显像后，对骨盆的异常浓聚灶行SPECT/CT融合显像。经组织病理学检查和（或）影像学检查（SPECT、CT、SPECT/CT、MRI）随访6个月至1年，通过随访结果，比较SPECT平面骨显像与SPECT/CT融合显像诊断骨转移的符合率、准确率和阳性预测值。定性资料的比较采用Pearson χ2检验；采用单因素方差分析比较多个影像学检查的阳性预测值。 结果 SPECT平面骨显像共检出309个代谢增高病灶，其中239个与随访结果相符，诊断符合率为77.3%（239/309），诊断骨转移的准确率为92.9%（208/224），诊断良性病变的准确率为77.3%（34/44）。SPECT/CT融合显像共检出367个代谢增高病灶，其中349个与随访结果相符，诊断符合率为95.1%（349/367），诊断骨转移的准确率为98.4%（299/304），诊断良性病变的准确率为87.7%（50/57）。SPECT平面骨显像与SPECT/CT融合显像在诊断符合率、骨转移的诊断准确率、良性病变的诊断准确率间的差异均有统计学意义（χ2=0.595、28.795、4.546，均P<0.01）。SPECT/CT融合显像在骨盆病变中检出的病灶数多于SPECT平面骨显像，原发盆腔肿瘤组检出病灶数多于非原发盆腔肿瘤组，且差异有统计学意义（χ2=17.385，P=0.036）。各种影像学检查的阳性预测值以SPECT/CT最高（84%，52/62），其余依次为SPECT（79%，48/61）、MRI（76%，47/62）和 CT（65%，39/60），其阳性预测值间的差异有统计学意义（F=5.492，P=0.003）。 结论 与SPECT平面骨显像相比，99Tcm-MDP SPECT/CT可以提高肿瘤患者骨盆转移灶鉴别诊断的准确率和原发性盆腔肿瘤骨转移灶的检出率。

Diagnostic value of SPECT/CT bone fusion imaging in pelvic lesions of tumor patients

Objective To evaluate the diagnostic value of 99Tcm-methylene disphosphonate (MDP) SPECT/CT fusion imaging in pelvic metastases in tumor patients. Methods The clinical data of 148 patients diagnosed with malignant tumor and suspected bone metastasis were retrospectively analyzed in Sichuan Cancer Hospital from August 2018 to December 2018. The patients, composed of 77 males and 71 females aged 29–86 (48.8±14.5) years, were divided into primary pelvic tumor group (63 cases) and non-primary pelvic tumor group (85 cases). All the patients underwent SPECT/CT fusion imaging of the abnormal concentration of the pelvis after first SPECT whole-body plane bone imaging. After 6 months to 1 year of follow-up with histomathological examination and imaging examination(SPECT, CT, SPECT/CT, and MRI), the coincidence rates, accuracy, and positive predictive values of SPECT whole-body plane bone imaging and SPECT/CT fusion imaging in the diagnosis of bone metastasis were compared. Qualitative data were compared by Pearson χ2 test. One-way analysis of variance was used in comparing the positive predictive values of multiple imaging tests. Results A total of 309 lesions with increased metabolism were detected through SPECT whole-body plane bone imaging, of which 239 were consistent with the follow-up results. The diagnostic coincidence rate was 77.3% (239/309), the accuracy rate of bone metastasis was 92.9% (208/224), and the accuracy rate of benign lesions was 77.3% (34/44). A total of 367 lesions with increased metabolism were detected by SPECT/CT fusion imaging, of which 349 were consistent with the results obtained through follow-up. The diagnostic coincidence rate was 95.1% (349/367), the accuracy rate of bone metastasis was 98.4% (299/304), and the accuracy rate of benign lesions was 87.7% (50/57). Statistically significant differences in diagnostic coincidence rate, diagnostic accuracy of bone metastasis, and diagnostic accuracy of benign lesions were found (χ2=0.595, 28.795, 4.546, all P<0.01). The number of lesions detected by SPECT/CT fusion imaging in the pelvic lesions was higher than that detected through SPECT whole-body plane bone imaging, and the number of lesions detected in the primary pelvic tumor group was higher than that in the non-primary pelvic tumor group, and the difference was statistically significant (χ2=17.385, P=0.036). The positive predictive value of SPECT/CT was the highest (84%, 52/62), followed by those of SPECT (79%, 48/61), MRI (76%, 47/62), and CT (65%, 39/60), and the differences were statistically significant (F=5.492, P=0.003). Conclusion Compared with SPECT plane bone imaging, 99Tcm-MDP SPECT/CT can improve the accuracy of differential diagnosis of pelvic metastases in tumor patients, and the application of 99Tcm-MDP SPECT/CT fusion examination can improve the detection rate of bone metastases in primary pelvic tumors.