^(18)F-FDG PET/CT对原发灶不明的骨转移瘤的诊断价值

^(18)F-FDG PET/CT for Diagnosing Bone Metastases of Unknown Primary Tumor

目的探讨18F-FDGPET/CT对原发灶不明的骨转移瘤的诊断价值。资料与方法回顾性分析经病理证实的72例原发灶不明的骨转移瘤患者的PET/CT资料,记录原发灶部位、骨转移部位及骨外转移部位(包括前哨淋巴结及脏器)并按CT骨转移诊断标准进行分类,测量其最大标准摄取值。结果 PET/CT显像检查确定61例原发灶,11例未找到原发灶。66例为多发骨转移,6例为单发骨转移;原发灶部位依次为肺癌(31例)、前列腺癌(6例)、胃癌(4例)、结肠癌(3例)、甲状腺癌(3例)等;溶骨性转移以肺癌(22例)、胃肠癌(7例)多见,成骨性骨转移以前列腺癌(5例)、肺癌(4例)多见,混合性骨转移以肺癌(5例)、鼻咽癌(2例)多见;胸部骨及脊柱转移多见肺癌(31例),骨盆及脊柱转移多见肺癌(23例)、前列腺癌(6例)。结论 PET/CT诊断原发灶不明的骨转移瘤时,需根据骨转移的类型、部位及前哨淋巴结和脏器转移的位置找出原发灶,必要时进一步行穿刺活检明确诊断。

Purpose To investigate the value of ^18 F-fluorodeoxyglucose （ ^18 F-FDG） PET/CT in diagnosing bone metastases of unknown primary tumor （BMUPT）. Materials and Methods PET/CT findings of 72 patients with pathology proven BMUPT were retrospectively analyzed. The primary site, bone metastases, sentinel lymph nodes and organ metastases were observed. Bone metastases were classified according to the diagnostic criteria of bone metastasis by CT, and the maximum standard uptake values （SUV max ） were measured. Results 61 cases of primary tumor were identified by PET/CT. The primary tumor was not detected in 11 cases. 66 were multiple bone metastases, and 6 were single bone metastasis. Primary sites were lung （n=31）, prostate （n=6）, stomach （n=4）, colon （n=3）, thyroid cancer （n=3） in order; osteolytic metastasis was mostly seen in lung cancer （n=22） and gastrointestinal cancer （n=7）; osteoblastic metastasis was mostly seen in prostatic cancer （n=5） and lung cancer （n=4）; mixed metastasis was mostly seen in lung cancer （n=5） and nasopharyngeal carcinoma （n=2）. The chest bone and spinal metastases was mostly seen in lung cancer （n=31）. The pelvic and spinal metastases were mostly seen in lung cancer （n=23） and prostatic cancer （n=6）. Conclusion 18 F-FDG PET/CT may play an important role in diagnosing BMUPT according to the classification and site of bone metastasis and also location of sentinel lymph node and other organ metastasis, to identify the primary tumor. If necessary, further biopsy can be performed for diagnosis.