^(18)F-NaF PET/CT对初始肺癌患者骨转移诊断的价值

The Value of ^(18)F-NaF PET/CT in the Detection of Bone Metastases in Recently Diagnosed Lung Cancer Patients

目的:通过与常规^(99m)Tc-MDP骨显像(bone scintigraphy,BS)比较,研究^(18)F标记氟化钠PET/CT(^(18)F-NaFPET/CT)对初始肺癌患者骨转移诊断的价值。方法:34例初始诊断的肺癌患者在1周内完成BS和^(18)F-NaFPET/CT检查,分别在患者水平和病变水平对BS和^(18)F-NaF PET/CT的诊断结果按照五点等级评分,进行受试者特征曲线(ROC)分析,ROC曲线下面积反映诊断系统的准确性。骨转移的评价方法包括MRI(34例)、^(18)F-FDGPET/CT(4例)、组织学活检(2例)和临床随访(6例)。结果:按患者水平分析,34例患者中的11例(32.3%)发生骨转移。^(18)F-NaF PET/CT诊断真阳性11例(100%),2例不确定诊断,无假阳性和假阴性。BS诊断真阳性6例(55.0%),5例患者不确定诊断,假阴性3例,假阳性2例。按病变水平分析时,117个病变获得最终诊断,其中转移病变47个,良性病变70个。^(18)F-NaF PET/CT诊断真阳性病变47个,2个病变不能确定(良性)。BS诊断真阳性病变24个(51%),真阴性病变48个,不确定诊断9个,假阳性4个,假阴性2个,其余病变被BS忽略。按患者水平和病变水平分析时^(18)F-NaF PET/CT的ROC分析曲线下的面积分别为0.978(BS为0.781,P<0.05)和0.986(BS为0.725,P<0.05)。根据^(18)F-NaF PET/CT的结果4例患者(11.7%)治疗方案发生改变。结论:^(18)F-NaFPET/CT是初始肺癌患者骨转移诊断的有效手段,其诊断准确性优于BS。与BS比较^(18)F-NaF PET/CT检查结果对患者的治疗计划产生显著影响。

Objective： To evaluate the effect of 18F-NaF PET/CT imaging on the management of patients recently diagnosed with lung cancer, we compared findings obtained with ^18F-NaF PET/CT and those obtained with conventional bone scintigraphy （BS）. Methods： Thirty-four patients with recently diagnosed lung cancer were prospectively examined with ^18F-NaF PET/CT and BS within 1 week. Both imaging modalities were compared with patient-based analysis and lesion-based analysis using a five-point scale for the receiver operating characteristic （ROC） curve analysis. The area under the ROC curve represented the efficacy of each technique. For comparison of the areas under the ROC curves, a P value of less than 0.05 was considered statistically significant. A panel of reference methods was used, including MRI （34 patients）, ^18 F-FDG PET/CT （4 patients）, histopathology （2 patients）, and clinical follow-up of at least 6 months （6 patients）. Results： In patient-based analysis, 11 of the 34 patients had bone metastases. ^18F-NaF PET/CT correctly diagnosed all 11 patients with bone metastases, while BS alone correctly detected only 6 of them （55%）. ^18F-NaF PET/CT had no false diagnoses, but 2 scans provided inconclusive results. BS produced 2 false-positives, 3 false-negatives and equivocal results in 5 cases. In lesion-based analysis, 117 lesions were assessed （47 metastases, 70 benign lesions）. ^18F-NaF PET/CT was correct in diagnosing 47 metastatic lesions and 68 benign lesions, but the results were equivocal for 2 lesions （benign lesions）. BS was correct in assessing 24 （51%） metastatic lesions and 48 benign lesions, but the technique was wrong for 6 lesions （4 benign lesions and 2 metastatic lesions） and inconclusive for 9 lesions （4 metastatic lesions and 5 benign lesions）, and others were missed. For ^18F-NaF PET/CT, the area under the ROC curve was 0.986 for lesion-based data （for BS it was 0.725, P〈 0.05） and 0.978 for patient-based data （for BS it was 0.781, P〈0.05）. As a result of ^18F-NaF PET/CT imaging, clinical management was changed in 4 of the 34 patients （11.7%）. Conclusion： ^18F-NaF PET/CT is both sensitive and specific in the detection of bone metastases in patients with recently diagnosed lung cancer. Such accurate detection has a significant effect on clinical management.