骨显像半定量分析法评估骨肉瘤侵袭范围初探

Primary study of bone scanning semi-quantitative method for measurement extension of appendicular osteosarcoma

目的寻找一种评估骨肉瘤侵袭范围的骨显像半定量方法,探讨骨显像如何更准确测量肢体骨肉瘤骨侵袭范围。方法回顾性分析病理证实的23例骨肉瘤患者,均于术前行全身骨扫描。设计骨显像放射性计数变化率阈值法,放射性计数变化率R=(T-NT)/NT×100%,公式转化为T=R×0.01×NT+NT,假设多个R值,获得多个肿瘤边界T值,手工移动T值感兴趣区,即可获得肿瘤范围测量值,同时采用骨显像目测法测量肿瘤范围,以病理范围为标准进行对比研究,采用配对t检验,分析各方法准确性。结果骨显像目测法与病理范围有显著性差异(t=-3.041,P=0.006<0.01)。骨显像阈值法R取80%(t=-1.519,P=0.143>0.05)、100%(t=-0.642,P=0.527>0.05)、120%(t=0.192,P=0.850>0.05)、140%(t=1.178,P=0.252>0.05)时与病理范围无显著性差异,R取100%及120%时平均差值最小。骨显像目视法测量结果与病理测量结果误差在10 mm内、20 mm内及30 mm内的病例数比率分别为39.1%(9/23)、56.5%(13/23)及73.9%(17/23),骨显像半定量分析法,R=100%时相应比率为65.2%(15/23)、87.0%(20/23)及95.7%(22/23),R=120%时相应比率为69.6%(16/23)、91.3%(21/23)及95.7%(22/23)。结论在评估骨肉瘤远关节面骨侵袭范围方面,骨显像放射性计数变化率阈值法提供了较目视法客观准确的测量值,建议R阈值取100%或120%。

Objective To find a bone imaging semi - quantitative method of assessing invasion of osteosarcoma , to explore how to measure the limb osteosarcoma bone invasion accurately. Methods 23 patients diagnosed as osteosarcoma by histology were included. Preoperative whole body bone scan were analyzed retrospectively. Bone scan radioactive count changing - rate threshold method was designed. The radioactive count changing - rate R = （T - NT） / NT x 100% was conversed into T = R x0.01 x NT ＋ NT. With assuming multiple R values, different tumor boundary T values were obtained. With regions of interest （ROI） of T values moved manually, tumor extent can be obtained. While tumor range measured by visual methods of bone scintigraphy compared to pathological range as the standard. Paired t - test was used to analyze the accuracy of the methods. Results The differences between bone scanning visual method estimates and pathologic measurements were statistically significant （ t = -3. 041, P = 0. 006 〈 0.01 ）. There was no significant difference between bone scan threshold method and pathologic range, with radioac- tive count changing - rate R = 80% （ t = - 1.519, P = 0. 143 〉 0.05）, R = 100% （ t = - 0. 642, P = 0. 527 〉 0.05）, R = 120% （ t = 0. 192, P = 0. 850 〉 0.05） , R = 140% （ t = 1. 178, P = 0. 252 〉 0.05 ）. When R = 100% and 120% , average difference was minimum. The differ- ences between pathologic range and T1WI measurement was graded as ＋ 10 mm, 20 mm and ＋ 30 mm level , which contained 69.6% （ 16/23 ）, 91.3 % （21/23） and 95.7% （22/23） of patients. The corresponding proportions of bone scanning visual method were 39.1% （9/23）, 56.5 % （13/23） and73.9% （17/23）. The bone scan threshold method were 65.2% （15/23）, 87.0% （20/23） and 95.7% （22/23） with R= 100%. The bone scan threshold method were 69. 6% （16/23）,91.3% （21/23）7J..95.7% （22/23）withR=120%. Conclusion Inassessing far - articular bone invasion range, bone scan radioactive count changing - rate threshold method is more objective and accurate than visual method. R = 100% or R = 120% were surgested.