SPECT/低剂量CT融合显像技术在肺癌骨转移诊断中的应用

目的探讨SPECT/低剂量CT融合显像在肺癌骨转移诊断中的应用价值。方法选取59例肺癌疑似骨转移患者行99m Tc-MDP全身骨显像及SPECT/低剂量CT融合显像,以随访结果或活检病理学检查结果为诊断标准,比较两种检查方式诊断骨转移的灵敏度,特异度,准确率,阴性、阳性预测值,并分析肺癌骨转移影像学表现。结果1)59例肺癌患者疑似骨转移病灶146处,经随访确诊肺癌骨转移病灶115处,其中发生于脊椎51处,占44.35%,胸廓30处,26.09%,骨盆16处,占13.91%,四肢11处,占9.56%,颅骨7处,占6.09%;2)SPECT/低剂量CT融合显像诊断肺癌骨转移灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为:99.13%、93.55%、98.28%、93.55%、97.95%,均高于SPECT全身显像的97.39%、67.74%、91.80%、87.5%、91.10%,其中特异度、阳性预测值及准确率差异有统计学意义(Fisher=10.144、5.688、7.101,P<0.05);3)鳞癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为42.86%、28.57%、14.29%、7.14%、7.14%;溶骨性、成骨性骨破坏分别为75.00%、25.00%;腺癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为46.34%、26.83%、13.41%、7.32%、6.10%;溶骨性、成骨性骨破坏分别为68.29%、30.49%,鳞癌、腺癌骨转移部位及骨破坏类型差异无统计学意义(P>0.05)。结论SPECT/低剂量CT融合显像在鉴别诊断肺癌骨转移方面具有良好临床价值,肺腺癌骨转移发生率较高。

Application of SPECT/low-dose CT fusion imaging in the diagnosis of bone metastases from lung cancer

Objective To explore the value of SPECT/low-dose CT fusion imaging in diagnosis of bone metastases from lung cancer.Methods A total of 59 lung cancer patients with suspected bone metastases were selected for 99m Tc-MDP whole body imaging and SPECT/low-dose CT fusion imaging checking.Follow-up results or biopsy pathological examination results were adopted as diagnostic standard.We compared the sensitivity,specificity,accuracy,negative and positive predictive value of the two examinations in the diagnosis of bone metastases,and analyzed the bone metastases of lung cancer.Results 1)There were 146 suspected bone metastases in 59 patients with lung cancer.Among them,115 bone metastases were confirmed by follow-up,of which 51 occurred in the spine,accounting for 44.35%,30 in the thorax,accounting for 26.09%,16 in the pelvis,accounting for 13.91%,and 11 in the limbs,accounting for 9.56%,7 in the skulls,accounting for 6.09%;2)The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of SPECT/low-dose CT fusion imaging in the diagnosis of lung cancer were 99.13%,93.55%,98.28%,93.55%,and 97.95%,respectively,which were higher than those of 97.39%,67.74%,91.80%,87.5%,and 91.10%of SPECT whole body imaging,of which the difference in specificity,positive predictive value,and accuracy was statistically significant(Fisher=10.144,5.688,7.101,P<0.05);3)For squamous cell carcinoma,the rates of metastasis of the spine,thorax,pelvis,limbs,and skull were 42.86%,28.57%,14.29%,7.14%,and 7.14%,respectively;osteolytic and osteogenic bone destruction were 75.00%and 25.00%,respectively.As for carcinoma,the metastatic rates of the spine,thorax,pelvis,limbs,and skull were 46.34%,26.83%,13.41%,7.32%,and 6.10%,respectively.The osteolytic and osteogenic bone destruction were 68.29%and 30.49%,respectively.There was no significant difference in bone metastasis and bone destruction in adenocarcinoma(P>0.05).Conclusion The SPECT/low-dose CT fusion imaging technique has good effection in the differential diagnosis of bone metastases from lung cancer.The incidence of bone metastases in lung adenocarcinomas is high.