多模态显像在嗜铬细胞瘤/副神经节瘤骨转移诊断中的对比研究

目的:对比研究^(131)I-MIBG显像、^(18)F-FDG PET/CT显像与^(99)Tc^(m)-MDP-WBS多模态显像在嗜铬细胞瘤/副神经节瘤(PCC/PGL)骨转移病灶中的诊断价值。方法:回顾性分析本院收治的PCC/PGL患者共30例,所有患者均伴骨转移且已行以上三种检查(检查的时间间隔为3个月内)。以病理、影像学检查及临床随访结果作为骨转移的诊断依据。比较三种检查方法检测PCC/PGL骨转移病灶的灵敏度、特异性、阳性及阴性预测值和准确性。使用SPSS 25.0软件分析,采用McNemar检验比较三种检查方法诊断骨转移的价值。结果:30例PCC/PGL患者共检查出骨异常病灶302处,确诊为骨转移病灶271处。^(131)I-MIBG显像、^(18)F-FDG PET/CT显像与^(99)Tc^(m)-MDP-WBS在诊断PCC/PGL骨转移病灶时的灵敏度、特异性、阳性和阴性预测值及准确性分别是92.00%、96.30%、99.60%、54.17%、92.38%;96.00%、92.59%、99.25%、69.44%、95.70%和88.39%、62.86%、94.78%、41.51%、85.43%。三种检查方法在诊断PCC/PGL骨转移病灶时^(18)F-FDG PET/CT显像灵敏度最高,^(131)I-MIBG显像特异性最好。三种检查方法的诊断效能经McNemar检验,差异有统计学意义(P<0.05)。结论:^(131)I-MIBG显像可作为PCC/PGL骨转移的首选检查方法并指导后续^(131)I-MIBG治疗,^(18)F-FDG PET/CT显像和^(99)Tc^(m)-MDP-WBS可作为可疑病灶^(131)I-MIBG显像阴性时的有效补充。

Comparison of multimodal imaging for diagnosis of bone metastases in patients with pheochromocytoma and paraganglioma

Objective:To compare the diagnostic ability of 131I-MIBG scan,18F-FDG PET/CT scan and 99Tcm-MDP-WBS for the detection of bone metastases from pheochromocytoma(PCC) and paraganglioma(PGL).Methods:Thirty patients of PCC/PGL with bone metastases were retrospectively analysed.All patients were examined with 131I-MIBG scan,18F-FDG PET/CT scan and 99Tcm-MDP-WBS with a maximum interval of three months.Bone metastases were verified either by tumor pathologies or imaging methods or follow-up more than six months.The McNemar's test was used to compare the diagnostic ability of the three inspection methods.All analyses were performed with SPSS 25.0 and P value<0.05 was considered statistically significant difference.Results:A total of 302 abnormal lesions were detected in the 30 patients with PCC/PGL,with 271 lesions were diagnosed as being true positive.In patient-based analysis,the sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of 131I-MIBG scan were 92.00%,96.30%,99.60%,54.17% and 92.38%,respectively.Those of 18F-FDG PET/CT were 96.00%,92.59%,99.25%,69.44% and 95.70%,and those of 99Tcm-MDP-WBS were 88.39%,62.86%,94.78%,41.51% and 85.43%,respectively.The sensitivity of 18F-FDG PET/CT was the highest and 131I-MIBG has the best specificity,while 99Tcm-MDP-WBS has poor sensitivity and specificity in the diagnosis of bone metastasis of PCC/PGL.Comparing the diagnostic ability using the McNemar test,the three modalities were significantly different(P＜0.05).Conclusion:131I-MIBG scan remains to be the first choice in detecting PPGL with bone metastasis to guide the follow-up 131I-MIBG treatment.However，a negative finding of 131 I-MIBG scan cannot rule out the diagnosis of bone metastasis,then 18F-FDG PET/CT,99Tcm-MDP-WBS can be performed．