MRI与骨扫描诊断前列腺癌骨转移的比较

Comparison between MRI and bone scintigraphy in detecting bone metastasis of prostate cancer

目的：通过比较MRI与核素骨扫描对前列腺癌骨转移的诊断，以选择最优的无创成像手段来明确前列腺癌的分期。材料与方法回顾性分析2011年1月—2013年6月经病理证实为前列腺癌的病人252例。年龄57~88岁，平均年龄（73±7.98）岁，分别获取并比较MRI和骨扫描对前列腺癌骨转移诊断的敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值（NPV）。结果54例病人诊断为骨转移（成骨性骨转移48例，混合性骨转移6例）。80%（41/54）的前列腺癌骨转移病人的前列腺特异性抗原（PSA〈50 ng/mL，而92%（182/198）的前列腺癌无骨转移病人的PSA〈50 ng/mL。 MRI 诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV 分别为85.1%、100%、96.8%、100%、96.1%；全身骨扫描诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为92.5%、84.3%、86.1%、61.7%、97.6%。结论 MRI对前列腺癌骨转移的诊断特异度、准确度及PPV较高，骨扫描的敏感度较高。 MRI与骨扫描可以实现优势互补，利于前列腺癌的准确临床分期。

Objective To compare the value between MRI and bone scintigraphy in detecting bone metastasis of prostate cancer, then choose the best noninvasive way to make a accurate staging. Methods and Materials A retrospective study of 252 cases, pathology proved prostate cancer from 2011 January to 2013 June, age range 57-88 years, mean age 73±7.98 years. The sensitivities, specifilities, accuracies, values of PPV and NPV of MRI and Bone Scintigraphy in detecting bone metastasis of prostate cancer were calculated. Results Fifty-four patients were diagnosed having bone metastasis （48 cases with osteoblastic bone metastasis, six cases with mixed metastasis）, and 41 of 54 patients （80%） with bone metastasis of prostate cancer had PSA〉50 ng/mL, while 182 of 198 patients （92%） without bone metastasis had PSA〈50 ng/mL. The sensitivity, specifility, accuracy, PPV,and NPV of MRI in detecting bone metastasis of prostate cancer was 85.1%, 100%, 96.8%, 100%and 96.1%, respectively;while for bone scintigraphy was 92.5%, 84.3%, 86.1%, 61.7%and 97.6%, respectively. Conclusion MRI has higher specificity, accuracy, and PPV, while bone scintigraphy has higher sensitivity in detecting bone metastasis of prostate cancer. MRI and bone scintigraphy can provide complementary information and may help in staging prostate cancer accurately.