^99Tc^m-MDP全身骨显像、^99Tc^m—MDP SPECT-CT和^18FFDG SPECT-CT探测脊柱转移瘤的比较

Comparision of the value of ^99Tc^m-MDP bone scintigraphy, ^99Tc^m-MDP SPECT-CT and lSF-FDG SPECT-CT in detecting bone metastases of spine

目的比较^88T以^m亚甲基二膦酸盐（^99Tc-MDP）全身骨显像、^99Tc-MDP SPECT-CT与^18FFDG SPECT-CT诊断脊柱转移瘤的临床价值。方法对行常规^99Tc^m-MDP全身骨显像的88例肿瘤患者同时行^99Tc-MDP SPECT-CT，同期（2周内）行^18F-FDG SPECT—CT。回顾性分析患者临床资料，以病理结果或两种以上影像技术（MRI、CT等）结果或随访2年以上结果为最终结果，比较^99Tc^m-MDP全身骨显像、^99Tc^m—MDP SPECT—CT与^18F—FDG SPECT—CT的诊断结果。结果经临床随访或病理证实，88例肿瘤患者诊断脊柱转移瘤48例、良性病变19例、未转移21例。^99Tc^m-MDP全身骨显像诊断脊柱转移瘤的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为89．6％（43／48）、62．5％（25／40）、74．1％（43／58）、83．3％（25／30）及63．4％（68／88），^99Tc^m-MDP SPECT—CT分别为93．8％（45／48）、92．5％（35／40）、90．O％（45／50）、92．1％（35／38）及81．6％（80／88）；^18F—FDG SPECT-CT分别为97．9％（47／48）、97．5％（39／40）、97．9％（48／49）、97．5％（39／40）及87．8％（86／88）。SPECT—CT解决了^99Tc^m-MDP全身骨显像对阳性病灶精确解剖定位难的问题，明显提高了对骨良性病灶的诊断能力，降低了诊断脊柱转移瘤的假阳性率。^18F-FDG SPECT—CT较^99Tc^m—MDP全身骨显像更具肿瘤特异性，对骨骼良恶性病灶的鉴别具有更强的能力，提高了脊柱转移瘤诊断的特异度（X^2=15．313，P〈0．001）和准确率（X^2=16．831，P〈0．001）。结论^99Tc^m-MDP SPECT—CT和^18F-FDG SPECT—CT对脊柱转移瘤的诊断效能高于^99Tc^m-MDP全身骨显像，具有较高的临床价值。

Objective To co mpare the value of ^99Tc^m-methylene diphosphonate （^99Tc^m-MDP）bone scintigraphy, ^99Tc^m-MDP SPECT-CT and 18F-FDG in detecting bone metastases of spine. Methods Retro-speerive analysis of 88 tumor patients who underwent ^99Tc^m-MDP planar bone seintigraphy, then perfolxaed ^99Tc^m- MDP SPECT-CT immediately, and then underwent ^18F-FDG SPECT-CT within 2 weeks apart. The diagnostic results were confirmed by biopsy, MRI/CT and clinical follow-up. Results Fouty-eight of 88 patients were comfirmed to be spine bone metastases, 19 to be spine benigns, 21 to be non-metastases. The sensitivity, speci- ficity, positivity predicitive value, negative predictive value, and accuracy of ^99Tc^m-MDP bone scintigraphy were 89.6%（43/48）, 62.5%（25/40）, 74.1% （43/58）, 83.3% （25/30）and 63.4%（68/88）. Those of ^99Tc^m-MDP SPECTCT were 93.8% （45/48）, 92.5% （35/40）, 90.0% （45/50）, 92.1% （ 35/38 ）and 81.6% （ 80/88 ）. Those of I8F-FDG SPECT-CT were 97.9% （47/48）, 97.5% （39/40）, 97.9% （48/49）, 97.5% （39/40） and 87.8% （86/88）. SPECT-CT is resolving the problem in conventional bone seintigraphy on anatomical localization of the positive lesions on bone, and reducing the false positive rate. ^18F-FDG SPECT-CT is more specific than ^99Fc^m-MDP bone scintig- raphy to the bone metastases of spine, and increasing the ability to identify bone lesion malignant or benign, and increasing the specificity（X^2=15.313, P〈0.001 ） and aceuracy（X2=16.831, P〈0.001 ）. Conclusion The dia-gnostic accuracy of ^99Fc^m-MDP SPECT-CT and ^18F-FDG SPECT-CT in detecting bone metastases of spine are both better than ^99Tc^m-MDP BS.They are valuable for detecting bone metastases of spine.