SPECT/CT融合图像对脊柱单发病灶鉴别诊断的增益价值

The Added Value of SPECT/ CT Fusion Imaging for Differential Diagnosis of Spinal Solitary Lesions in Patients with Malignant Tumors

目的：探讨SPECT/CT融合图像较SPECT图像在脊柱单发病灶鉴别诊断方面的增益价值。方法：193例恶性肿瘤患者在全身骨显像发现脊柱单发浓聚病灶后行SPECT/CT显像。由2名核医学科医师结合全身骨显像分别对SPECT图像和SPECT/CT融合图像进行分析,对脊柱病灶诊断分为：肿瘤骨转移、良性病变、不能确定诊断。并按SPECT/CT融合图像比SPECT图像对诊断是否具有增益价值分为：有帮助、不确定、无帮助。将观察指标分为肯定组和否定组,分别计算其百分率及95%可信区间。结果：对193处病灶的分析结果显示,SPECT图像能确定诊断（肿瘤骨转移和良性病变）的病灶共59处,占30.6%（59/193）,其95%可信区间为24.1%-37.1%;不能确定诊断的病灶共134处,占69.4%（134/193）,其95%可信区间为62.9%-75.9%。SPECT/CT融合图像能确定诊断的病灶共175处,占90.7%（175/193）,其95%可信区间为86.6%-94.8%;不能确定诊断的病灶共18处,占9.3%（18/193）,其95%可信区间为5.2%-13.4%。与SPECT图像对比,SPECT/CT融合图像对诊断有帮助者173处,占89.6%（173/193）,其95%可信区间为85.3%-93.9%;不确定18处和无帮助2处共20占10.4%（20/193）,其95%可信区间为6.1%-14.7%。结论：在对脊柱单发病灶是否为肿瘤骨转移的鉴别诊断方面SPECT/CT融合图像较SPECT图像具有增益价值,可以提供更多的诊断信息。

Objective： The study is to evaluate the added value of SPECT/ CT fusion imaging in identifying metastases from benign lesions of the spinal solitary hot spot in patients with extraskeletal malignancy.Methods： We selected 193 cases with malignancy,whose bone scintigraphy demonstrated a solitary accumulation hot spot in the spine.SPECT/CT was undergone for those lesions.SPECT and SPECT/CT images were analyzed by two experienced nuclear medicine physicians separately.Each lesion was rated using a 3-point diagnostic confidence scale： metastasis,benign or uncertain.Comparison between the SPECT/CT fusion images and SPECT images was graded on a 1-3 scales： helpful,unsure or not helpful.The percentage and 95% confidence intervals of each group were calculated.Results： A total of 193 lesions in spinal were evaluated.The degree of certainty to diagnose on SPECT images was 30.6%（59/193）,its 95% confidence intervals range from 24.1% to 37.1%.The degree of certainty to diagnose on SPECT/CT images was 90.7%（175/193）,its 95% confidence intervals range from 86.6% to 94.8%.Moreover,SPECT/CT images provided additional confidence for image interpretation [helpful 89.6%（173/193）,unsure and not helpful 11.4%（20/193）].The 95% confidence intervals of regarding the SPECT/CT images as helpful ranged from 85.3% to 93.9%.Conclusion： SPECT/CT fusion imaging provides more information than SPECT imaging in identifying metastases from benign lesions of the spinal solitary hot spot in patients with extraskeletal malignancy and could obviously increase readers′ diagnostic confidence.