SPECT-CT融合图像评价乳腺癌骨转移的增益价值

目的：探讨SPECT-CT融合图像评价乳腺癌骨转移的增益价值.方法：回顾分析经病理证实为乳腺癌、排除其他恶性肿瘤病史且行全身骨显像（whole-body bone scintigraphy,WBBS）及局部SPECT-CT（single photon emission computed tomograpby-computed tomography）融合图像检查的53例女性患者的临床资料,根据患者综合表现诊断为肿瘤骨转移、无肿瘤骨转移和不能确定,以手术病理或随访结果为最终诊断标准.分别计算并比较WBBS、SPECT-CT融合图像对病例及病灶诊断的灵敏度、特异度、阳性预测值、阴性预测值、正确诊断百分率、肿瘤骨转移诊断符合率和无肿瘤骨转移诊断符合率.结果：53例患者中确诊为肿瘤骨转移者27例,无肿瘤骨转移者26例;在共计177个病灶中,95个病灶确诊为肿瘤骨转移,82个病灶确诊为无肿瘤骨转移.WBBS对病例和病灶诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为92.6％和93.7％、61.5％和73.2％、71.4％和80.2％、88.9％和90.9％;正确诊断百分率、肿瘤骨转移诊断符合率、无肿瘤骨转移诊断符合率分别为56.6％（30/53）和72.1％（111/177）、51.9％（14/27）和61.1％（58/95）、61.5％（16/26）和73.2％（60/82）.SPECT-CT融合图像对病例和病灶诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为96.3％和98.9％、84.0％和95.1％、86.7％和95.9％、95.7％和98.7％;正确诊断百分率、肿瘤骨转移诊断符合率、无肿瘤骨转移诊断符合率分别为90.6％（48/53）和97.2％（172/177）、96.3％（26/27）和98.9％（94/95）、88.5％（23/26）和95.1％（78/82）,均高于WBBS（病例分析：x2分别为15.725、13.886和5.026,P值分别为0.000、0.000和0.025;病灶分析：x2分别为55.618、42.632和14.809,P值均为0.000）.结论：评价乳腺癌骨转移时,SPECT-CT融合图像较WBBS更具有增益价值.

Incremental Diagnostic Value of SPECT-CT Fusion Imaging for Bone Metastases from Breast Cancer

Objective：To investigate the incremental diagnostic value of SPECT-CT fusion imaging for bone metastases from breast cancer.Methods：A total of 53 female patients with breast cancer but without other malignancy,confirmed by pathological examination,underwent routine whole-body bone scintigraphy（WBBS） and local SPECT-CT.Patients were divided into positive bone metastases group,negative bone metastases group and uncertain group according to the comprehensive manifestation.The final diagnosis was confirmed by clinical follow-up or surgical pathology.Sensitivity,specificity,positive predictive value,negative predictive value,diagnostic accuracy,bone and non-bone metastatic diagnostic accordance rate of WBBS and SPECT-CT for cases and lesions were computed and compared.Results：Within 53 patients,27 were diagnosed as positive bone metastases and the other 26 patients were diagnosed as negative bone metastasis.Within 177 lesions,95 were diagnosed as positive bone metastases and the other 82 lesions were diagnosed as negative bone metastasis.Sensitivity,specificity,positive predictive value,negative predictive value,diagnostic accuracy,bone and non-bone metastatic diagnostic accordance rate of SPECT-CT for cases and lesions were 96.3％ and 98.9％,84.6％ and 95.1 ％,86.7％ and 95.9％,95.7％ and 98.7％,90.6％ （48/53） and 97.2％ （172/177）,96.3 ％ （26/27） and 98.9％ （94/95）,88.5 ％ （23/26） and 95.1％ （78/82）,respectively,much higher than those of WBBS,[92.6％ and 93.7％,61.5％ and 73.2％,71.4％ and 80.2％,88.9％ and 90.9％,56.6％（30/53） and 72.1（111/177）,51.9％（14/27） and 61.1％（58/95）,61.5％（16/26） and 73.2（60/82）].Conclusions：SPECT-CT fusion imaging provides incremental diagnostic value over routine WBBS for bone metastases from breast cancer.