PET/CT显像中SUVmax对骨转移瘤与骨髓瘤鉴别诊断的价值

目的 回顾性分析未知原发灶的多发性骨破坏患者PET/CT显像中骨髓瘤与骨转移瘤病变SUVmax的特征,为临床鉴别诊断提供依据.方法 CT或MRI发现的多发骨破坏患者119例,其中71例PET/CT检查后行病理检查,男40例,女31例;年龄37～87岁,平均61-3岁.病理确诊骨髓瘤21例,骨转移瘤41例.测量骨髓瘤和骨转移瘤每个骨病变的SUVmax并进行比较,采用ROC曲线获得鉴别诊断的分界点.采用单因素方差分析比较不同形态学特征(溶骨性和成骨性)骨转移瘤与骨髓瘤SUVmax的差异.结果 PET/CT在骨髓瘤病例中共检出315个病灶,在骨转移瘤病例中共检出684个病灶.骨髓瘤病灶SUVmax(3.42±1.96)值明显低于转移瘤病灶(7.03±4.15).SUVmax值为4.45时,鉴别骨髓瘤和骨转移瘤的敏感性和特异性分别为80.4%和72.4%.溶骨性骨转移瘤病灶SUVmax值(8.02±4.85)明显高于成骨性骨转移瘤(4.79±2.61)和骨髓瘤(3.37±1.92),而成骨性骨转移瘤与骨髓瘤病灶的SUVmax值差异无统计学意义(P>0.05).结论 PET/CT对未知原发灶的多发性骨破坏患者骨髓瘤与骨转移瘤的鉴别诊断具有潜在的价值,多发性骨破坏病灶SUVmax值较低和溶骨性破坏可提示骨髓瘤.

The value of SUV of FDG-PET/CT in differentiation of myeloma and metastasis in patients with malignant skeletal diseases of unknown origin

Objective To conduct a comparison of the standardized uptake value (SUV) of positron emission tomography/computed tomography (PET/CT) in myeloma and multiple bone metastasis disease. Methods A total of 119 patients with osteolysis were analyzed. There were 40 males and 31 females, with the mean age of 61.3 years. There were myelomas in 21 patients bone metastases diease in 41 patients,confirmed by histological section. Lesions of meyloma and bone metastasis disease were calculated. Feasible cutoff values of differentiation were determined by using the receiver operating characteristic (ROC) curve based positive test. A Comparion of the SUVmax between the multiple bone metastasis disease and myeloma was performed. Restlts PET/CT identified increased FDG uptake in 315 lesions in patients with myeloma, and 684 lesions in patients with metastases. SUVmax of myelomas were lower than metastastic lesions. The value of 4.45 had been proved to be appropriate in the differentiation of myeloma and multiple bone metastasis disease, the diagnostic sensitivity and specificity was 80.4% and 72.49b respectively. The SUVmax of osteolystic metastastic lesions were significantly higher than that of osteogenic metastastic lesions and lesions of myeloma, but no difference was found between the osteogenic metastastic lesions and lesions of myeloma. Conclusion FDG-PET/CT had potential value in the differentiation of myeloma and multiple bone metastasis diseases. Low SUVmax and uncertainty of origin suggested myeloma.