肺癌骨转移骨闪烁现象的CT表现

CT Features of Bone Flare Phenomena of Metastatic Bone Disease in Lung Cancer

目的骨闪烁现象在核素骨显像对骨转移瘤疗效监测中的描述比较详尽,而MSCT对该现象的研究鲜有报道,且此现象易被误认为疾病进展。本文探讨经伊班膦酸治疗后的肺癌骨转移患者CT骨闪烁现象及其CT特征,以提高对此现象的认识。资料与方法回顾性分析45例经临床和病理确诊为肺癌骨转移患者经伊班膦酸治疗前、治疗后3、6个月的临床资料和影像学资料,对治疗后3个月骨闪烁组、疾病进展1组及疾病进展2组骨转移灶的CT值及CT特征进行比较。结果骨闪烁现象的发生率为6.7%（3/45）。治疗后3个月,骨闪烁组、疾病进展1组的CT值与治疗前比较,差异均有统计学意义（t=-5.787、-2.788,P〈0.001、P〈0.05）,疾病进展2组治疗后3个月的CT值与治疗前比较,差异无统计学意义（t=1.691,P〉0.05）。治疗后3个月骨闪烁组大多表现为溶骨型病灶发生成骨性硬化改变,疾病进展组大多表现为病灶新发骨膜反应、成骨或混合型病灶伴溶骨性破坏,两组比较差异有统计学意义（χ^2=10.139、8.041、4.154,P〈0.01、P〈0.05）。两组成骨型病灶密度是否增加,差异无统计学意义（χ^2=0.059,P〉0.05）。结论肺癌骨转移经伊班膦酸治疗后3个月,当骨转移疗效评价（疾病进展）与临床综合疗效评价（有效）结果不一致时,可以用骨闪烁现象解释,CT特征改变的分析有助于其与疾病进展的鉴别。

Purpose The bone flare phenomena has been well described on bone scintigraphy for efficacy monitoring up to now, but our knowledge has been rarely described on MSCT, the phenomena may be erroneously classified as disease progression. This article intends to evaluate the existence and CT features of bone flare phenomena of metastatic bone disease in lung cancer patients treated with ibandronate, to raise awareness of this phenomenon. Materials and Methods The clinical and image data of 45 patients with bone metastases of lung cancer were retrospectively analyzed prior to treatment and 3, 6 months after treatment, the change of CT value and CT features 3 months after treatment between bone flare phenomena group, progressive disease group 1 and progressive disease group 2 were compared. Results The incidence of bone flare phenomena was 6.7%（3/45）. 3 months after treatment, CT value of the bone flare phenomena group and progressive disease group 1 changed when compared with before treatment, the differences were statistically significant（t=- 5.787 and- 2.788, P〈0.05） and there was no statistically significant difference（t=1.691, P〉0.05） of CT value in the progressive disease group 2 after 3 months’ treatment. After 3 months’ treatment, the bone flare phenomena group mostly appeared as osteogenic sclerosis of osteolytic lesions, while the cases of progressive disease group mostly appeared as new periosteal reaction of the lesion, or osteogenic/ mixed lesion combined with osteolytic damages, the difference between the two groups was statistically significant（χ~2=10.139, 8.041 and 4.154, P〈0.01, P〈0.05）. There was no statistically significant difference in increase of density in osteosclerotic lesions（χ~2=0.059, P〉0.05）. Conclusion In patients treated with ibandronate, when there is therapeutic effect evaluation standard of bone metastases（disease progression） and clinical comprehensive curative effect evaluation standard（effective） discordance at 3 months after treatment, it can be interpreted as bone flare phenomena, and the change of CT features contributes to the differential diagnosis of bone flare phenomena with progressive disease.