CT与全身核素骨显像联合诊断单发骨转移瘤

CT combined with radionuclide whole-body bone imaging in diagnosis of single bone metastasis

目的评价全身骨显像、CT及二者联合诊断在单发骨转移病变定性诊断中的价值。方法对102例全身骨显像表现为单发异常核素分布的恶性肿瘤患者行骨病变部位CT扫描。全身骨显像、CT及二者联合分别做出诊断,并与随访结果和病理对照。结果 102例患者,经随访和病理证实有53例为骨转移瘤。全身骨显像、CT与二者联合诊断骨转移瘤灵敏度分别为90.57%(48/53)、86.79%(46/53)、100%(53/53);特异度分别为61.22%(30/49)、97.96%(48/49)、91.84%(45/49);准确率分别为76.47%(78/102)、92.16%(94/102)、96.08%(98/102);阳性预测值分别为71.64%(48/67)、97.87%(46/47)、92.98%(53/57);阴性预测值分别为85.71%(30/35)、87.27%(48/55)、100%(45/45)。CT诊断特异度、准确率及阳性预测值优于全身骨显像(P<0.05)。二者联合诊断特异度、准确率及阳性预测值明显优于单纯全身骨显像(P<0.05),灵敏度和阴性预测值明显优于单纯CT(P<0.05)。结论 CT有助于区分全身骨显像单发病变的良恶性。全身骨显像与CT联合诊断可明显提高肿瘤患者单发骨转移瘤的诊断准确率。

Objective To observe the diagnosis value for solitary bone metastasis in patients with malignant tumor with bone scan,CT scan and combination analysis.Methods 99mTc-methylenebisphosphonate（MDP） bone scan was performed on patients with malignant tumor,102 patients with bone solitary lesion were selected and underwent CT scan immediately after bone scan.The final diagnosis was proved by clinical follow-up or pathology.Results Fifty-three patients in 102 cases were diagnosed bone metastases.The diagnostic sensitivity of bone scan,CT and combination analysis was 90.57%（48/53）,86.79%（46/53）,100%（53/53）;the specifcity was 61.22%（30/49）,97.96%（48/49）,91.84%（45/49）;the accuracy was 76.47%（78/102）,92.16%（94/102）,96.08%（98/102）;the positive predictive value was 71.64%（48/67）,97.87%（46/47）,92.98%（53/57）;the negative predictive value was 85.71%（30/35）,87.27%（48/55）,100%（45/45）,respectively.CT scan was superior to bone scan in specificity,accuracy and the positive predictive value（P0.05）.There was significant different in specificity,accuracy and the positive predictive value between CT combined bone scan and bone scan（P0.05）,and in sensitivity and the negative predictive value between CT combined bone scan and CT alone（P0.05）.Conclusion CT contributes to distinguishing benign and malignant solitary bone metastasis with bone scan.The combination of CT and bone scan can improve accordance obviously in diagnosis of solitary bone metastasis.