18F-FDG符合线路显像对骨骼单发病灶的鉴别诊断

目的:探讨18F-脱氧葡萄糖(FDG)显像对骨显像单个病灶的鉴别诊断价值。方法:99mTc-亚甲基二磷酸盐(MDP)骨显像提示骨骼单个病灶的恶性肿瘤患者38例,骨显像后1~2周接受18F-FDG代谢显像。根据病灶穿刺活检、3~12个月随访期内有无骨痛及MRI检查判断单个病灶是否为骨转移。以此为标准,计算18F-FDG显像对骨骼单个病灶的诊断效能。结果:病灶穿刺活检证实为骨转移瘤21例,随访期内出现骨痛,复查全身骨显像提示其它部位骨骼出现新的病灶而诊断骨转移4例,2例经MRI证实为骨转移;其余11例为良性病变。38例患者发生骨转移27例,发生率71.0%(27/38)。18F-FDG显像提示骨骼病灶高代谢27例,但其中1例为骨结核,另1例为放射性炎症。18F-FDG显像对骨骼单个病灶的诊断灵敏度为92.5%(25/27),特异性为81.8%(9/11),诊断符合率89.5%(34/38),阳性预测值92.5%,阴性预测值81.8%。结论:18F-FDG代谢显像可对骨骼单个病灶准确鉴别。在脊椎骨、骨盆等部位能更灵敏地发现病灶。

Differential diagnosis of single lesion on bone scan with 18F-FDG DHTC

Objective: To evaluate the differential diagnostic value for single bone lesion in patients with malignant tumor with 18F-fluorodeoxyglucose(FDG) dual-head tomography with coincidence(DHTC). Methods: 99mTc-methylenebisphosphonate(MDP) bone scan was performed on patients with malignant tumor, and thirty-eight cases showed up single lesion. These patients underwent 18F-FDG DHTC one to two weeks after bone scintigraphy. These single lesions obtained final diagnoses according to: ostalgia during follow-up period, biopsy consequence from bone lesions and MRI examinations. Results: Twenty-one cases were diagnosed as osseous metastasis on the basis of biopsy, bone ache showed up on four patients during follow-up phase and bone scan once again indicated more spots, and other two patients were confirmed metastases by MRI. On the whole, twenty-seven patients were diagnosed metastases finally, the other eleven cases were confirmed benign lesions. So the incidence rate of osseous metastases among thirty-eight cases was 71.0%. On 18F-FDG DHTC, twenty-seven cases were judged as positive, among which one was comfirmed bone tuberculosis and another was inflammation caused by radiation. So its diagnostic sensitivity was 92.5%(25/27), specificity was 81.8%(9/11), the accordance rate was 89.5%(34/38), its positive predictive value was 92.5% and the negative predictive value was 81.8%. Conclusions: 18F-FDG DHTC has high clinical value in the differential diagnosis of malignant or benign single lesion on bone scan, especially to the lesions located at vertebra and pelvis.