SPECT和CT融合骨显像在小儿神经母细胞瘤中的应用

目的探讨SPECT和CT融合骨显像在探测小儿神经母细胞瘤（NB）转移性骨肿瘤中的临床价值。方法回顾性分析24例NB患儿，均行全身平面骨显像及局部SPECT和CT融合骨显像。将骨病灶显示的清晰度分为5级（不可见、模糊、可见、清晰、非常清晰），良恶性诊断的确定性分为3级（不确定、可以确定、十分确定），诊断效能指标包括灵敏度、特异性及准确性。对显像图像在骨病灶的清晰度显示、良恶性确定性诊断及探测恶性骨病灶的诊断效能方面进行分析，采用秩和检验及χ^2检验进行比较。结果24例NB患儿，全身平面骨显像发现骨病灶72个，有5个骨病灶未能显示，SPECT和CT融合显像和单独SPECT显像均分别发现骨病灶77个。对骨病灶的清晰度显示SPECT和CT融合显像，单独SPECT显像均优于平面显像（日值均为69．000，P均〈0．05）。平面显像和SPECT显像诊断恶性骨病灶的准确性分别为45．45％（35／77）和62．34％（48／77；χ^2=4．416，P〈0．05），SPECT和CT融合诊断恶性骨病灶的灵敏度、特异性和准确性均较平面显像有提高，分别为82．35％（42／51）和53．19％（25／47）、88．46％（23／26）和40．00％（10／25）、84．42％（65／77）和45．45％（35／77），χ^2=12．571，14．016和25．667，P均〈0．01。与SPECT显像的特异性（14／26，53．85％）和准确性（48／77，62．34％）相比，SPECT和cT融合诊断恶性骨病灶的特异性和准确性提高（χ^2=7．589，9．606，P均〈0．01），两者间灵敏度差异无统计学意义（χ^2=2．942，P〉0．05）。SPECT和CT融合显像骨病灶良恶性的确定性诊断优于SPECT（H=28．000，P〈0．05）和平面显像（H=21．000，P〈0．05）。结论SPECT和CT融合骨显像能探测到NB患儿更多的骨病灶，是一种较好的探测NB患儿转移性骨肿瘤的显像方法。

Bone SPECT and CT fusion imaging in pediatric neuroblastoma

Objective To evaluate the diagnostic performance of bone SPECT and CT fusion imaging in bone metastases from pediatric neuroblastoma.Methods Twenty-four pediatric patients with neuroblastoma were included in this retrospective study.All patients underwent planar imaging and SPECT integrated with CT.Lesion visibility,diagnostic certainty and diagnostic performance were evaluated with KolmogorovSmirnov test andx2 test.Results Lesion visibility of SPECT alone,SPECT integrated with CT were significantly better than that of planar imaging ( both H =69.000,P ＜ 0.05 ).SPECT and CT fusion imaging,SPECT alone both detected five more bone lesions than planar bone imaging (77 vs 72).The diagnostic accuracy of SPECT imaging (62.34％,48/77 ) was significantly higher than that of planar imaging (45.45％,35/77; x2 =4.416,P ＜ 0.05 ).The sensitivity,specificity and accuracy of SPECT and CT fusion imaging for diagnosing malignant bone lesions were significantly higher than those of planar imaging:82.35％ (42/51) vs 53.19％ ( 25/47),88.46％ ( 23/26 ) vs 40.00％ ( 10/25 ),84.42％ ( 65/77 ) vs 45.45％ (35/77 ; x2 =12.571,14.016,25.667,all P ＜ 0.01 ).The diagnostic specificity and accuracy of SPECT and CT fusion imaging were significantly higher than those of SPECT alone ( 53.85％,14/26 ;62.34％,48/77) (x2 =7.589,9.606,both P ＜0.01 ).However,there was no significant difference of sensitivity between the two methods (x2 =2.942,P ＞ 0.05 ).Diagnostic certainty by SPECT and CT fusion imaging was significantly higher than that by SPECT alone ( H =28.000,P ＜ 0.05 ) and by planar imaging (H =21.000,P ＜ 0.05).Conclusion SPECT and CT fusion imaging can detect more bone lesions in patients with pediatric neuroblastoma.It is helpful for diagnosing bone metastases from pediatric neuroblastoma.