SPECT/CT同机融合显像对前列腺癌骨转移的诊断价值及影像学特征的研究

Diagnostic value and imaging characteristics of SPECT/CT fusion imaging to bone metastasis of prostate cancer

目的:通过对前列腺癌患者进行99m Tc-MDP SPECT/CT同机融合显像,研究99m Tc-MDP SPECT/CT融合显像在前列腺癌骨转移诊断中的价值及其影像学特征。方法:入选92例经病理证实为前列腺癌且高度怀疑有骨转移患者,同时行99mTc-MDP全身骨扫描及SPECT/CT融合显像。通过对比分析二者的灵敏度、特异性、准确性,进而评价SPECT/CT融合显像在前列腺癌骨转移定性诊断中的价值。并分析骨转移灶的部位、数量以及CT表现特点,以获得前列腺癌骨转移放射性分布特征以及骨质破坏特征。结果:全身骨显像与SPECT/CT融合显像诊断前列腺癌骨转移的灵敏度分别为87.5%、95.7%,特异性分别为55.7%、89.1%,准确性分别为62.0%、92.3%。SPECT/CT的准确性高于全身骨显像,差异有统计学意义(P<0.05)。242处骨转移灶位于骨盆38.4%,脊柱30.9%,四肢15.3%,胸廓11.6%,颅骨3.7%。CT图像成骨性转移90.5%,混合性转移7.8%,溶骨性转移1.7%。结论:99mTc-MDP SPECT/CT融合显像对前列腺癌骨转移诊断的灵敏度、特异性、准确性较高,具有良好的临床应用价值。其影像学特征:转移灶以中轴骨为主,多灶转移;CT表现以成骨性转移多见,混合性及溶骨性转移少见。

Objective To research the diagnostic value of 99mTc-MDP SPECT/CT fusion imaging to bone metastasis of prostate cancer and the imaging features. Methods： 92 patients with pathologically confirmed prostate cancer and highly suspected bone metastasis received 99mTc-MDP whole body bone scan and SPECT/CT fusion imaging at the same time. The sensitivity, specificity and accuracy of the two methods were compared. Results The sensitivity of whole body bone scan and SPECT/CT fusion imaging was 87.5% and 95.7%. The specificity was 55.7%and 89.1%, and the accuracy was 62%and 92.3% respectively. The accuracy of SPECT/CT was higher than that of whole body bone scan （P〈 0.05）. Of 242 bone metastasis, 38.4% in the pelvis, 30.9% in the spine, 15.3% in the extremities, 11.6% in the chest, and 3.7% in the skull. CT images showed that osteoblastic metastasis accounted for 90.5%, mixed meta stasis 7.8%, and lytic metastasis 1.7%. Conclusion99mTc-MDP SPECT/CT fusion imaging has higher sensitivity, specificity, and accuracy in diagnosis of bone metastasis of prostate cancer, with good clinical application value. Imaging features showed that most metastases occur in the axial skeleton, with multifocal metastasis. CT features showed that osteoblastic metastasis is more common than mixed and osteolytic metastases.