SPECT／CT骨显像对肺癌骨转移诊断的增益价值

目的探讨SPECT／CT骨显像在肺癌骨转移诊断中的增益价值。方法146例病理证实为肺癌的患者，静脉注射^99Tc^m-MDP1110MBq，3～6h后按常规方法行全身骨显像。由1位资深核医学科医师分析全身骨显像图像后，决定是否行SPECT／CT显像以及显像视野范围，然后采集SPECT和CT图像。由2位核医学科医师先对全身骨显像的平面图像进行分析，然后分析SPECT／CT融合图像并诊断，诊断分为肿瘤骨转移、无肿瘤骨转移和不能确定。根据术后病理或随访获得正确诊断，分别计算全身骨显像、SPECT／CT融合图像对患者能正确（肿瘤骨转移和无肿瘤骨转移）诊断和不能正确诊断（不能确定和诊断错误）的百分率及其95％可信区间，并分别计算其诊断与最终诊断的符合率及其95％可信区间。全身骨显像和SPECT／CT能否正确诊断的百分率比较采用，检验。结果全身骨显像正确诊断者65例，占44．5％（65／146）；不能正确诊断者81例，占55．5％（81／146），其95％可信区间为47．4％一63．5％；骨转移诊断的符合率为64．4％（29／45）。SPECT／CT融合图像能正确诊断者131例，占89．7％（131／146）；不能正确诊断者15例，占10．3％（15／146），其95％可信区间为5．3％～15．2％；骨转移诊断的符合率为93．3％（42／45）。SPECT／CT融合图像的明确诊断率高于全身骨显像（χ2=69．598，P〈0．05）。结论SPECT／CT骨显像在肺癌骨转移诊断中较全身骨显像有增益价值，可以提供更多的诊断信息。

The added diagnostic value of SPECT/CT imaging for bone metastases from lung cancer

Objective To investigate the added diagnostic value of SPECT/CT imaging over routine planar whole-body bone scintigraphy (WBBS) for bone metastases from lung cancer. Methods One hundred and forty-six patients with lung cancer, confirmed by pathological examination, underwent routine 99Tcm-MDP (1110 MBq) WBBS, followed by SPECT/CT over the regions with indeterminate findings on WBBS. Both WBBS and bone SPECT/CT images were interpreted by two experienced nuclear medicine physicians in consensus as the positive, negative or uncertain bone metastases. The final diagnosis was comfirmed by pathology or clinical follow-up. x2 test was used to compare the differences between the two imaging methods. Results Finally, 45 patients were diagnosed as positive bone metastases and the other 101 as negative. The diagnostic sensitivity of bone SPECT/CT for bone metastases from lung cancer was 93.3%(42/45), singnificantly higher than that of WBBS (64.4%, 29/45) (x2 = 19.944, P＜0.05). The diagnostic accuracy of bone SPECT/CT was 89.7% ( 131/146), much higher than that of WBBS (44.5%,65/146) ( x2 = 69. 598,P ＜ 0.05). The uncertain and incorrect diagnostic rates of bone SPECT/CT and WBBS were 10.3% ( 15/146, raging from 5.3% to 15.2% with 95% confidence interval (CI) ) and 55.5% (81/146, raging from 47. 4% to 63.5% with95% CI), respectively. Conclusion BoneSPECT/CT provides incremental diagnostic value over routine WBBS for bone metastases from lung cancer.