18F-FDG显像、CT及肿瘤标记物测定等检查在确诊肺癌单发骨显像转移病灶中的临床价值

The clinical values of 18F-FDG, CT and tumor markers in diagnosing single bone metastases of lung cancer

目的探讨18F-FDG显像、CT及肿瘤标记物测定等检查在确诊肺癌单发骨显像转移病灶中的临床价值。方法回顾性研究188例病理确诊为肺癌的患者,进行99mTc-MDP全身骨显像示单发异常放射性浓聚灶,同时行18F-FDG显像(53例)、CT(106例)、肿瘤标记物的测定(168例),各种检查间隔时间不超过2周,以组织病理学、MRI等检查以及临床随访结果为确诊依据。结果 188例患者最终84例(44.68%)证实为骨转移,104例(55.32%)为良性病变。18F-FDG显像、CT及肿瘤标记物检测的敏感性为95.23%、71.70%、84.85%(χ2=6.477,P<0.05),特异性为93.75%、73.58%及66.67%(χ2=9.125,P<0.05),准确率为94.34%、72.64%及73.81%(χ2=11.009,P<0.05),阳性预测值为90.91%、73.08%及60.87%(χ2=7.321,P<0.05),阴性预测值为96.77%、72.22%及87.18%(χ2=9.948,P<0.05)。其中53例患者利用三种方法相结合综合诊断的敏感性为100%、特异性为96.88%、准确性为98.11%、阳性预测值为95.45%和阴性预测值为100%。单发浓聚灶中以胸部骨(38.10%)和中轴骨(36.90%)转移最为常见。各种类型肺癌中,腺癌的骨转移率最高(56.99%)。结论 18F-FDG显像在对全身骨显像单发异常浓聚灶的诊断中较其他方法更好,并且多种检查方法相结合能够提高诊断率。

Objective To explore the clinical values of 18F-FDG,CT and tumor markers in diagnosing bone metastases of lung cancer.Methods Conducting retrospective study in 188 cases of patients who were diagnosed with lung cancer,99mTc-MDP bone scintigraphy was used to display single hot spots,at the same time 18F-FDG imaging(53 cases),CT(106 cases),and the tumor marker determination(168 cases)were did,interval time of all examinations was no more than two weeks.The histopathology,MRI examination and clinical follow-up outcomes were the foundation of clinical diagnosis.Results 84 cases(44.68%)in 188 cases were confirmed with skeletal metastasis,104(55.32%)were benign lesions.The sensitivity of 18F-FDG imaging,CT and tumor markers was 95.23%,71.70%,84.85%(χ2=6.477,P<0.05);separately,specificity was 93.75%,73.58%,66.67%(χ2=9.125,P<0.05),the accuracy was 94.34%,72.64%,73.81%(χ2=11.009,P<0.05),the positive predictive value was 90.91%,73.08%,60.87%(χ2=7.321,P<0.05),negative predictive value was 96.77%,72.22%,87.18%(χ2=9.948,P<0.05).In 18F-FDG imaging,53 patients used the three examinations together,the integrated diagnosis sensitivity was 100%,specificity was 96.88%,accuracy was 98.11%,the positive predictive value was 95.45% and negative predictive value was 100%.It was single strong focal thoracic(38.10%)and axial skeletal metastasis(36.90%)that were most common.Adenocarcinoma had the highest skeletal metastasis rate(56.99%)among all lung cancers.Conclusions 18F-FDG imaging is better than other methods in diagnosis of single hot spots on whole bone scintigraphy,and it can improve the diagnosis to combine with other examinations.