^(18)F-FDG符合线路显像对骨骼单发病灶的鉴别诊断

Differential diagnosis of single lesion on bone scan with ^(18)F-FDG DHTC

目的:探讨18F-脱氧葡萄糖(FDG)显像对骨显像单个病灶的鉴别诊断价值。方法:99mTc-亚甲基二磷酸盐(MDP)骨显像提示骨骼单个病灶的恶性肿瘤患者38例,骨显像后1～2周接受18F-FDG代谢显像。根据病灶穿刺活检、3～12个月随访期内有无骨痛及MRI检查判断单个病灶是否为骨转移。以此为标准,计算18F-FDG显像对骨骼单个病灶的诊断效能。结果:病灶穿刺活检证实为骨转移瘤21例,随访期内出现骨痛,复查全身骨显像提示其它部位骨骼出现新的病灶而诊断骨转移4例,2例经MRI证实为骨转移;其余11例为良性病变。38例患者发生骨转移27例,发生率71.0%(2738)。18F-FDG显像提示骨骼病灶高代谢27例,但其中1例为骨结核,另1例为放射性炎症。18F-FDG显像对骨骼单个病灶的诊断灵敏度为92.5%(2527),特异性为81.8%(911),诊断符合率89.5%(3438),阳性预测值92.5%,阴性预测值81.8%。结论:18F-FDG代谢显像可对骨骼单个病灶准确鉴别。在脊椎骨、骨盆等部位能更灵敏地发现病灶。

Objective： To evaluate the differential diagnostic value for single bone lesion in patients with malignant tumor with ^18F-fluorodeoxyglucose（FDG） dual-head tomography with coincidence（DHTC）. Methods： ^99Tc-methylenebisphosphonate （MDP） bone scan was performed on patients with malignant tumor, and thirty-eight cases showed up single lesion. These patients underwent ^18F-FDG DHTC one to two weeks after bone scintigraphy. These single lesions obtained final diagnoses according to： ostalgia during follow-up period, biopsy consequence from bone lesions and MRI examinations. Results： Twentyone cases were diagnosed as osseous metastasis on the basis of biopsy, bone ache showed up on four patients during followup phase and bone scan once again indicated more spots, and other two patients were confirmed metastases by MRI. On the whole, twenty-seven patients were diagnosed metastases finally, the other eleven cases were confirmed benign lesions. So the incidence rate of osseous metastases among thirty-eight cases was 71.0%. On ^18F-FDG DHTC, twenty-seven cases were judged as positive, among which one was comfirmed bone tuberculosis and another was inflammation caused by radiation. So its diagnostic sensitivity was 92.5%（25/27）, specificity was 81.8%（9/11）, the accordance rate was 89.5%（34/38）, its positive predictive value was 92.5% and the negative predictive value was 81.8%. Conclusions： ^18F-FDG DHTC has high clinical value in the differential diagnosis of malignant or benign single lesion on bone scan, especially to the lesions located at vertebra and pelvis.