SPECT/CT超级骨显像影像学特征、临床表现、年龄及实验室检查指标的分析

目的 探讨99Tcm-亚甲基二膦酸盐（MDP） SPECT/CT超级骨显像患者的影像学特征、临床表现、年龄及实验室检查结果的差异。 方法 收集2012年6月至2021年7月于宁夏医科大学总医院行99Tcm-MDP SPECT/CT显像的47 671例患者中呈超级骨显像的97例患者，其中男性54例、女性43例，年龄25~85（62.4±14.3）岁，回顾性分析97例患者的临床表现资料、影像学资料、年龄及实验室检查资料。根据病因不同，将患者分为骨转移瘤组（71例）与代谢性骨病组（26例，包括甲状旁腺瘤9例、肾性骨病6例、骨质疏松症11例）。根据原发肿瘤不同，将71例骨转移瘤组患者分为4个亚组[前列腺癌组（40例）、乳腺癌组（15例）、肺癌组（8例）、消化系统恶性肿瘤组（8例，包括胃癌4例、直肠癌2例、食管癌1例、原发性肝癌1例）]。统计分析骨转移瘤组与代谢性骨病组以及骨转移瘤组4个亚组之间99Tcm-MDP SPECT全身骨显像的特征、SPECT/CT融合显像的特征、临床表现、年龄和实验室检查[血钙、血磷、碱性磷酸酶（ALP）、乳酸脱氢酶（LDH）]结果的差异。计量资料的组间比较采用独立样本t检验、单因素方差分析、Wilcoxon秩和检验及Kruskal-Wallis H检验；分类变量资料的组间比较采用χ2检验。 结果 骨转移瘤（73.2%，71/97）是导致超级骨显像的最常见病因[在其原发肿瘤中，前列腺癌较常见（56.3%，40/71）]，其次为代谢性骨病（26.8%，26/97）。骨转移瘤组以灶性散在分布型（Ⅱ型）为主（85.9%，61/71），代谢性骨病组主要呈均匀对称型（ Ⅰ型）（61.5%，16/26），2组比较差异有统计学意义（χ2=21.84，P<0.001）。骨转移瘤组以成骨型（74.6%，53/71）和混合型（19.7%、14/71）骨质破坏为主，而代谢性骨病组以溶骨型（73.1%，19/26）骨质破坏为主，差异均有统计学意义（χ2=39.76、15.95，均P<0.001）。所有患者均以骨痛为初发症状，局部骨痛为主要临床表现（56.7%，55/97）。骨转移瘤组以腰痛最常见（60.0%，24/40），代谢性骨病组多为肋骨痛（40.0%，6/15），2组比较差异有统计学意义（χ2=11.11，P<0.05）。骨转移瘤组患者的年龄和ALP、LDH水平均高于代谢性骨病组，而血钙水平则低于代谢性骨病组，差异均有统计学意义（t=4.89，Z=−2.28、−3.65，t=−5.96，均P<0.05）；而2组患者在血磷水平上的差异无统计学意义（t=0.01，P>0.05）。骨转移瘤组4个亚组在SPECT全身骨显像的显像模式、SPECT/CT融合显像中的骨质破坏类型、临床表现、局部骨痛部位间的差异均无统计学意义（χ2=2.71~13.07，均P>0.05） 。骨转移瘤组4个亚组间进行比较，乳腺癌组患者年龄最小、前列腺癌组患者年龄最大，乳腺癌组患者血钙水平最高，肺癌组患者LDH水平最高，且差异均有统计学意义（F=14.43、5.13，H=13.47，均P<0.05）；血磷和ALP水平的差异均无统计学意义（F=2.41，H=6.28，均 P>0.05）。 结论 超级骨显像病因中以骨转移瘤最常见，其次为代谢性骨病。2种病因超级骨显像患者在99Tcm-MDP SPECT全身骨显像、病灶处99Tcm-MDP SPECT/CT融合显像、临床表现、年龄及实验室检查结果方面均有差异，99Tcm-MDP SPECT/CT在2种病因超级骨显像的鉴别中有一定价值。

Analysis of imaging features,clinical manifestations,age and laboratory examination indexes of SPECT/CT super bone scan

Objective To explore the differences in the imaging features, clinical manifestations, age, and laboratory examination results of patients who underwent 99Tcm-methylenediphosphonate (MDP) SPECT/CT super bone scan. Methods A total of 97 patients with super bone scan, including 54 males and 43 females, aged 25–85 (62.4±14.3) years, were recruited from 47 671 patients who underwent 99Tcm-MDP SPECT/CT imaging in the General Hospital of Ningxia Medical University from June 2012 to July 2021. The clinical manifestation, imaging, age, and laboratory examination data of the 97 patients were retrospectively analyzed. In accordance with different etiologies, the patients were divided into the bone metastases group (71 cases) and the metabolic bone disease group (26 cases, including parathyroid adenoma (9 cases), renal bone disease (6 cases), and osteoporosis (11 cases)). In accordance with the location of the primary tumor, 71 patients with bone metastases were divided into four subgroups (prostate cancer group (40 cases); breast cancer group (15 cases); lung cancer group (8 cases); malignant digestive system tumors (8 cases), including gastric cancer (4 cases), rectal cancer (2 cases), esophageal cancer (1 case) and primary liver cancer (1 case)). The differences in 99Tcm-MDP SPECT whole-body bone scan and SPECT/CT fusion imaging features, clinical manifestations, age, and laboratory examination (serum calcium, serum phosphorus, alkaline phosphatase (ALP), and lactate dehydrogenase (LDH)) results between the bone metastasis group and the metabolic bone disease group and among the four subgroups of the bone metastasis group were statistically analyzed. Independent samples t-test, one-way ANOVA, Wilcoxon rank sum test, and Kruskal-Wallis H test were used to compare measurement data, and χ2 test was applied to compare classified variable data. Results Bone metastases (73.2%, 71/97) were the most common cause of super bone scan (among the primary tumors, prostate cancer was more common (56.3%, 40/71), followed by metabolic bone disease (26.8%, 26/97)). The bone metastasis group mainly exhibited focal scattered distribution type (type Ⅱ, 85.9%, 61/71), and the metabolic bone disease group presented mainly homogeneous and symmetrical type (type Ⅰ, 61.5%, 16/26), and the difference between the two groups was statistically significant (χ2=21.84, P<0.001). Osteogenic (74.6%, 53/71) and mixed types (19.7%, 14/71) were the main types of bone destruction in the bone metastases group, while osteolytic type (73.1%, 19/26) was the main type of bone destruction in the metabolic bone disease group, and the differences were statistically significant (χ2=39.76, 15.95; both P<0.001). In all patients, bone pain was the first symptom, and regional bone pain was the main clinical manifestation (56.7%, 55/97). Low back pain was the most common symptom in the bone metastasis group (60.0%, 24/40) and rib pain was the most common symptom in the metabolic bone disease group (40.0%, 6/15) with a significant difference between the two groups (χ2=11.11, P<0.05). Patients with bone metastasis had higher age, serum ALP and LDH levels and lower serum calcium levels than patients with metabolic osteopathy with statistically significant differences (t=4.89; Z=−2.28, −3.65; t=−5.96; all P<0.05). However, there was no significant difference in serum phosphorus levels between the two groups (t=0.01, P>0.05). No significant differences in the types of bone destruction, clinical manifestations, and local bone pain sites in SPECT whole-body bone scan and SPECT/CT fusion imaging were found among the four subgroups of the bone metastasis group (χ2=2.71–13.07; all P>0.05). Among the four subgroups of the bone metastasis group, the patients with breast cancer had the lowest age and the highest serum calcium levels, the patients with prostate cancer had the highest age, and the patients with lung cancer had the highest LDH levels, the differences were statistically significant (F=14.43, 5.13; H=13.47; all P<0.05). There were no significant differences in serum phosphorus and ALP levels (F=2.41; H=6.28; both P>0.05). Conclusions Bone metastases, followed by metabolic bone disease, are the most common causes for super bone scan. There were differences in 99Tcm-MDP SPECT whole body bone scan, focal 99Tcm-MDP SPECT/CT fusion imaging, clinical manifestation, age, and laboratory examination results in patiens with the two etiologies of super bone scan. 99Tcm-MDP SPECT/CT has a certain value in the identification of the two etiologies by super bone scan.