肺癌骨转移SPECT/CT融合图像的影像学特点分析

目的:探讨99 Tcm-亚甲基二膦酸盐(methylene diphosphonate,MDP)单光子发射计算机断层/CT(single photon emission computed tomography/spiral computed tomography,SPECT/CT)所显示的肺癌骨转移病灶的图像特点及SPECT/CT显像对肺癌骨转移的诊断价值。方法:回顾分析113例病理证实为肺癌、初次全身骨显像及SPECT/CT显像诊断为肺癌骨转移的患者的骨转移病灶的SPECT/CT图像特点,经病理诊断或再次全身骨显像及SPECT/CT显像随访确认,分析SPECT/CT显像所示肺癌骨转移病灶的部位、数量、放射性分布及CT表现的特点。结果:113例患者共482处病灶纳入本研究,肺癌骨转移病灶429处。肺癌骨转移病灶中位于脊柱者占50.6%(217/429),胸廓者占29.1%(125/429),骨盆者占17.0%(73/429),四肢者占2.1%(9/429),颅骨者占1.2%(5/429)。肺癌骨转移病灶SPECT/CT图像表现为放射性异常浓聚者占90.7%(389/429),无放射性分布异常者占9.3%(40/429);CT图像表现为成骨性转移者占41.0%(176/429),溶骨性转移者占50.3%(216/429),混合性(兼有溶骨和成骨)转移者占4.0%(17/429),骨质形态学正常者占4.7%(20/429)。113例患者中有23例患者同时伴有良性病灶,共53处。结论:肺癌骨转移的部位以脊柱居首,胸廓次之;肺腺癌患者容易发生骨转移,以成骨性转移多见。SPECT/CT诊断肺癌骨转移病灶的敏感度和特异性均较高。

Analysis of SPECT/CT Fusion Imaging of Bone Metastases in Patients with Lung Cancer

Objective：To analyze the 99 Tcm-methylene diphosphonate single photon emission computed tomography/spiral computed tomography（SPECT/CT）fusion imaging of bone metastases in patients with lung cancer and to evaluate the value of SPECT/CT in differentiating metastases from benign bone lesions.Methods：A total of 113 patients with bone metastases from lung cancer confirmed by pathology underwent bone scintigraphy and SPECT/CT imaging.Metastatic bone sites,quantity,uptake of radiotracer,and CT manifestations of each lesion were analyzed via bone scintigraphy imaging and SPECT/CT fusion imaging.Results：A total of 482 lesions from113 patients were analyzed in this study.Among them,429 lesions were metastases.Metastatic sites included spine（50.6%）,thorax（29.1%）,pelvis（17.0%）,extremities（2.1%）,and skull（2.1%）.CT manifestations were osteoblastic（41.0%）,osteolytic（50.3%）,mixed（4.0%）,and normal（4.7%）.Among these lesions,the proportion of hot spots displayed on SPECT/CT pictures was 90.7%（389/429）,and the proportion of lesions with normal uptake of radiotracer was 9.3%（40/429）.There were 53 benign lesions in 23 patients with bone metastasis.Conclusions：The most frequent metastatic sites in patients with lung cancer are spine and thorax.Bone metastasis from squamous carcinoma is more common than from other types of lung cancer.The common CT manifestations are osteoblastic.The sensitivity and specificity of SPECT/CT fusion images for the diagnosis of bone metastatic lesions of lung cancer are high.