^(99)Tc^m-MIBI骨显像判断骨良恶性病变的初步应用

Preliminary Application of ^(99)Tc^m-MIBI Scintigraphy for Judgment of Bone Malignant and Benign Lesions

目的探讨99Tcm-甲氧基异丁基异腈(MIBI)在判断骨良恶性病变中的应用价值,并与99Tcm-亚甲基二膦酸盐(MDP)进行比较。方法对39例确诊为恶性肿瘤或怀疑有骨转移的患者,分别给予静脉“弹丸”注射99Tcm-MDP和99Tcm-MIBI,行99Tcm-MDP三相骨扫描和动态及静态99Tcm-MIBI显像。用视觉读片分析法和ROI定量分析法对两种显像方法进行比较。结果169个病灶中有139个确诊为骨转移。99Tcm-MDP显像和99Tcm-MIBI显像的敏感性分别是90.3%和68.4%(P<0.05),特异性分别是33.3%和96.7%(P<0.05),假阳性率分别是6.71%和1.04%。99Tcm-MDP摄取在骨的良恶性病变中差异无统计学意义,99Tcm-MIBI显像在恶性肿瘤和良性病灶的差异有统计学意义(P<0.05)。99Tcm-MIBI显像在探测股骨(96.0%vs76.0%)、肱骨(90.9%vs63.6%)和胫骨(88.9%vs55.6%)的癌转移灶方面比99Tcm-MDP敏感性高(P<0.05);与99Tcm-MDP相比,99Tcm-MIBI显像能较早发现17个骨转移灶,并对11个良性病灶和2个癌症骨转移导致的病理性骨折做出明确诊断。结论99Tcm-MIBI显像总的敏感性低于99Tcm-MDP,但特异性较高,假阳性率低,能较早发现骨转移灶并判断其良恶性,对评价骨转移癌并指导临床治疗有重要意义。

Objective The aim of this study was to assess the value of Tc-99m-hexakis-2-methoxyisobutylisonitrile （MIBI） scintigraphy diagnosing the malignant and benign bone lesions in comparison with a conventional bone tracer ^99T^m-methylene-diphosphonate （MDP）. Methods ^99Tc^m-MDP three-phase bone scintigraphy and ^99Tc^m-MIBI dynamic and quiet states scintigraphy were obtained from 39 patients with proved malignant diseases or suspected bone metastases after bolus injected intravenously radiopharmaceuticals, respectively. The results were compared with using film reading and regions of interesting （ROI） technique. Results 139 bone metastases were confirmed in 169 lesions. The sensitivity of ^99Tc^m-MDP or ^99Tc^m-MIBI scintigraphy was 90.3% or 68.4% （P〈0.05）, respectively;the specificity was 33.3% or 96. 7% （P〈0. 05）, respectively,the false positive rate was 6.71% or 1.04%. No statistical difference was appeared in both malignant tumors and benign lesions with ^99Tc^m-MDP scintigraphy. However, while with ^99Tc^m-MIBI scintigraphy, there were significant statistical difference （P〈 0. 05） both in malignant tumors and benign lesions. ^99Tc^m-MIBI scintigraphy could early detect 17 bone metastases and proved 11 lesions to be benign bone foci and 2 to be pathologic bone fractures. Conclusion Although ^99Tc^mMIBI scintigraphy has lower general sensitivity than ^99Tc^mMDP scintigraphy, it has higher specificity, lower false positive rate and can detect lesions early and judge the quality, which may be helpful in the evaluation and strategy of clinical therapy for bone metastases.