神经母细胞瘤股骨远端干骺端骨转移全身骨显像分析

Application of semiquantitative analysis of whole body bone imaging on distal femoral metaphysis osseous metastasis of neuroblastoma

目的评价全身骨显像半定量分析在神经母细胞瘤股骨远端干骺端骨转移中的应用价值。方法45例经病理证实的神经母细胞瘤患儿，按骨髓涂片、x线片、CT、MRI或临床随访结果等将其分为股骨远端干骺端转移组和无转移组，术前或术后行99Tc-MDP SPECT全身骨显像，以两种方法对其进行分析：①半定量分析法：对每个患儿双侧股骨远端干骺端及股骨骨干中段勾画ROI，并测定其平均计数，计算每个患儿干骺端／骨干的放射性比值；②视觉分析法：根据骨显像视觉分析诊断患儿是否存在股骨远端干骺端转移。比较这两种方法的诊断结果有无差异。结果半定量分析法：转移组及无转移组干骺端／骨干的放射性比值差异有统计学意义（t=8．334，P〈0．01）。半定量分析法诊断股骨远端干骺端转移的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为90．5％、95．7％、94．4％、86．4％及97．1％；视觉分析法分别为81％、100％、95．6％、100％及94．5％。两种方法诊断结果的差异无统计学意义（X2=0．68，P〉0．05）。结论放射性核素全身骨显像对神经母细胞瘤骨转移的诊断具有重要的价值，结合视觉分析法及半定量分析法可提高诊断的准确率。

Objective To evaluate the value of semiquantitative analysis of whole body bone imaging on distal femoral metaphysis osseous metastasis of neuroblastoma. Methods Twenty-nine patients with confirmed neuroblastoma by pathological reports were divided into group of metastasis and group of no metastasis by bone marrow slides, X-ray, CT, MRI or c, linical fullow-up. Whole body bone imaging was performed pre-or postoperation. All cases were analysed by two methods： （1）Semi-quantitative analysis： Regions of interest on bilateral distal femoral metaphysic and middle of femoral were drawn, and their average counts were measured. The ratio of radioactivity of distal temoral metaphysic to middle of femoral was calculated; （2）Visual analysis： Bilateral distal femoral metaphysic metastasis were diagnosed by visual analysis according to whole body bone imaging. The differences between this two methods were compared. Results There were differences of the ratio of radioactivity of distal femoral metaphysic to middle of femoral between group of metastasis and group of no metastasis（t =8.334, P〈0.01）, and there was no significant difference betweent the two methods（x2 =0.68, P〉0.05）. The sensitivivy, specificity, accuracy, positive predictive value and negative predictive value of semiquantitative analysis in detecting osseous metastasis were 90.5%, 95.7%, 94.4%, 86.4% and 97.1%, while visual analysis were 81%, 100%, 95.6%, 100% and 94.5%. Conclusions Radionuclide whole body bone imaging was of great importance in diagnosis of osseous metastasis of neuroblastoma. The diagnostic accuracy was improved by combination of visual analysis and semi-quantitative analysis.