单光子发射计算机断层显像/螺旋CT骨显像对脊柱单发病灶的鉴别诊断价值

 目的 探讨单光子发射计算机断层显像（single photon emission computed tomography，SPECT）/螺旋CT骨显像对脊柱单发病灶是否为肿瘤骨转移的鉴别诊断价值。方法 收集57例恶性肿瘤患者全身骨显像资料，筛选出脊柱单发浓聚后行病灶部位的SPECT/CT显像的资料。由2名核医学医师结合全身骨显像分别对SPECT图像和SPECT/CT融合图像进行分析，对脊柱病灶诊断分为肿瘤骨转移、良性病变以及不能确定诊断。分别计算SPECT图像和SPECT/CT融合图像能明确诊断和不能明确诊断的百分率及其95% CI，并采用χ²检验进行比较。结果 对57处病灶的分析结果显示，SPECT图像能明确诊断的病灶共26处，占45.6%（26/57），95%CI为32.7%~58.5%；不能明确诊断的病灶共31处，占54.4%（31/57），95%CI为41.4%~67.3%。SPECT/CT融合图像能明确诊断的病灶共52处，占91.2%（52/57），95%CI为83.9%~98.6%；不能明确诊断的病灶共5处，占8.8%（5/57），95%CI为1.4%~16.1%；SPECT/CT融合图像的明确诊断率显著高于SPECT图像（χ²=27.20，P<0.05）。结论 对脊柱单发病灶，SPECT/CT融合图像较单纯的SPECT图像能提供更多的诊断信息，可以明显提高诊断的准确性。

The differential diagnostic value of SPECT/spiral CT for spinal solitary lesions in patients with malignant tumor

Objective The study is to evaluate the differential diagnostic value of single photon emission computed tomography (SPECT)/spiral CT in identifying metastases from benign lesions of the spinal solitary hot spot in patients with extraskeletal malignancy. Methods We selected 57 cases with malignancy, whose bone scintigraphy demonstrated a solitary hot spot in the spine. SPECT/CT was undergone for those lesions. SPECT and SPECT/CT imaging was analyzed by two experienced nuclear medicine physicians separately. Each lesion was rated using a 3-point diagnostic confidence scale: metastasis, benign or uncertainty. The analysed items were divided into two groups (certainty to diagnose and uncertainty to diagnose). The percentage and its 95%CI of each group were calculated. Results The degree of certainty to diagnose on SPECT images was 45.6% (26/57) with 95%CI of 32.7%-58.5%. The degree of uncertainty to diagnose on SPECT images was 54.4% (31/57) with 95%CI of 41.4%-67.3%. The degree of certainty to diagnose on SPECT/CT images was 91.2% (52/57) with 95%CI of 83.9%-98.6%. The degree of uncertainty to diagnose on SPECT/CT images was 8.8% (5/57) with 95%CI of 1.4%-16.1%. The accuracy diagnostic rate markedly improved (χ²=27.20, P<0.05) by SPECT/CT images. Conclusions The diagnostic accuracy of SPECT/CT fusion imaging is improved markedly compared to SPECT imaging alone in patients with extraskeletal malignancies with the spinal solitary lesion.