SPECT／CT联合三相骨显像对骨骼良恶性病变鉴别诊断的增益价值

The added value of ^99Tc^m-MDP SPECT/CT combined with three-phase bone scintigraphy for differ- ential diagnosis in patients with suspected bone tumor

目的探讨三相骨显像联合SPECT／CT对骨骼良恶性病变鉴别诊断较单纯三相骨显像的增益价值。方法回顾分析2008年7月至2011年9月间临床怀疑骨肿瘤、并行三相骨显像联合SPECT／CT显像的45例患者，其中男28例，女17例，年龄11～82（44．1±21．2）岁。病灶均经外科手术治疗或穿刺活组织检查获得病理诊断。2位核医学科医师先分析三相骨显像图，判断病变良恶性；在其基础上，结合SPECT／CT融合图像分析，再次判断病变良恶性。与病理诊断结果比较，分别对单纯三相骨显像和SPECT／CT联合三相骨显像对患者病灶良恶性诊断效能进行分析。采用SPSS16．0软件，以，检验比较2种方法诊断的准确性。结果病理诊断恶性病变29例，良性病变16例。三相骨显像和SPECT／CT联合三相骨显像对骨骼良恶性病变的诊断灵敏度分别为96．6％（28／29）和100％（29／29），特异性分别为37．5％（6／16）和81．2％（13／16），阳性预测值分别为73．7％（28／38）和90．6％（29／32），阴性预测值分别为6／7和100％（13／13）。三相骨显像诊断准确性为75．6％（34／45），SPECT／CT联合三相骨显像诊断准确性提高至93．3％（42／45），两者差异有统计学意义（X^2=4．145，P〈0．05）。结论SPECT／CT联合三相骨显像对骨骼病灶良恶性病变判断的准确件辅三相骨显像明显根高．且有增希价值．

Objective To investigate the added value of SPECT/CT combined with three-phase bone scintigraphy for differential diagnosis in patients with suspected bone tumor compared with ^99Tc^m-MDP three-phase bone scintigraphy. Methods Forty-five patients with mean age （44.1 ± 21.2） years who were suspected to have bone tumors, underwent 99Tcm-MDP three-phase bone scintigraphy and SPECT/CT be- tween July 2008 and September 2011. They were retrospectively reviewed. All patients had pathological di- agnosis based on surgical resection or lesion biopsy. The three-phase bone scintigraphy images were ana- lyzed, and combined SPECT/CT images were then analyzed by two experienced nuclear medicine physi- cians. The third nuclear medicine physician would be consulted if there was disagreement between these two investigators. Each lesion was diagnosed as either malignant or benign. Compared with the pathology diag- nosis, the diagnostic ability of three-phase bone scintigraphy images and SPECT/CT combined with three- phase bone scintigraphy were evaluated. The diagnostic accuracy of three-phase bone scintigraphy images and SPECT/CT combined with three-phase bone scintigraphy were calculated, and x2 test was used to com- pare the difference between them. Results Among these 45 lesions, 29 were malignant and 16 benign. Using three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy for the differen- tial diagnosis of bone lesions, the sensitivity, specificity, positive predictive value and negative predictive value were 96.6% （28/29） vs 100% （29/29）, 37.5% （6/16） vs 81.2% （ 13/16）, 73.7% （28/38） vs 90.6% （29/32）, and 6/7 vs 100% （13/13）, respectively. The diagnostic accuracy of the three-phasebone scintigraphy was 75.6% （34/45）, and up to 93.3% （42/45） for the combined examination （X2 = 4. 145,P 〈 0.05 ）. Conclusions Compared with three-phase bone seintigraphy alone, the diagnostic accu- racy of SPECT/CT combined with three-phase bone scintigraphy is significantly improved. The combination might provide added value over three-phase bone seintigraphy for differential diagnosis in patients with sus- pected bone tumor.