胸腰椎体结核的18F-FDG PET/CT影像特点研究

目的 探讨胸腰椎体结核的18氟-氟代脱氧葡萄糖(18F-FDG)正电子发射断层扫描成像/计算机断层扫描成像(PET/CT)影像特点.方法 选取2007年1月至2015年5月于该院行18F-FDG PET/CT检查的98例胸腰椎体脊柱破坏患者为研究对象,根据病理学检查及随访结果分为结核组(n=27)和非结核组(n=71),比较两组病灶的18F-FDG PET/CT检查征象,采用二分类Logistic回归分析筛选出其中有统计学意义者.结果 结核组、非结核组分别发现42、114个病灶.结核组的病变累计连续椎体、椎间盘病变、椎体压缩性骨折、椎旁冷脓肿、“放射性冷区”、高病灶标准摄取值最大值(SUVmax)、略高SUVmax等征象的发生率显著高于非结核组(P＜0.05).二分类Logistic回归分析结果表明,病变累计连续椎体、椎间盘病变、椎体压缩性骨折、椎旁冷脓肿、“放射性冷区”这5个征象是患者诊断为胸腰椎体结核的独立因素(P＜0.05).其中病变累计连续椎体+椎间盘病变这个组合的敏感度、特异度、阳性预测值、阴性预测值、Youden指数为71.4％、81.6％、58.8％、88.6％、53.0％,诊断效能最高.结论 对胸腰椎体结核的诊断而言,病变累计连续椎体+椎间盘病变组合的诊断价值可能最高.

Study on 18F-FDG PET/CT imaging features of thoracolumbar tuberculosis

Objective To investigate the 18F-FDG PET/CT imaging features of thoracolumbar tuberculosis.Methods Nine-ty-eight patients with thoracolumbar vertebral column destruction receiving 18F-FDG PET/CT examination in our hospital from May 2005 to January 2017 were selected as the study subjects and divided into the tuberculosis(TB) group (n=27) and non-TB group (n=71) according to the result of pathology examination and follow-up.The 18F-FDG PET/CT signs were compared between the two groups,and the binary classification Logistic regression was used to screen out the signs with statistical significance.Results Forty-two lesions and 114 lesions were detected in the TB group and non-TB group respectively.The incidence rates of continuous vertebral body involvement,intervertebral disc lesion,vertebral body compression fractures,cold abscess," radioactive cold area",high lesion SUVmax and slightly higher SUVmax sign in the TB group were higher than those in the non-TB group(P＜ 0.05) The binary classification Logistic regression analysis results showed that continuous vertebral involvement,intervertebral disc lesion,vertebral body compression fractures,cold abscess and "radioactive cold area" were the independent factors for diagnosis of thoracolumbar TB(P＜0.05).The sensitivity,specificity,positive prediction value,negative predictionvalue and Youden index in the combination of continuous vertebral involvement + intervertebral disc lesion were 71.4％,81.6％,58.8％,88.6％,53.0％,respectively.Conclusion For the diagnosis of thoracolumbar TB,the combination of continuous vertebral involvement + intervertebral disc lesion has the highest diagnostic value.