^(99m)Tc-MDP SPECT/CT全身骨显像诊断前列腺癌骨转移的临床价值

Clinical value of ^(99m)Tc-MDP SPECT/CT whole body bone imaging in diagnosis of bone metastasis of prostate cancer

目的:探讨^(99m)Tc-MDP SPECT/CT全身骨显像诊断前列腺癌骨转移的临床价值。方法:纳入107例病理证实的前列腺癌患者,于2013年1月至2016年11月首先利用SPECT显像仪开展全身骨平面显像诊断,对发现异常的放射性浓聚灶进一步开展SPECT/CT断层显像诊断,于半年后再次开展全身骨平面显像及SPECT/CT骨断层显像诊断。上述诊断中骨显像剂均选择^(99m)Tc-MDP。根据临床及影像随访诊断结果诊断骨转移病灶,并以其为标准计算全身骨平面显像和SPECT/CT骨断层显像对前列腺癌骨转移的诊断效能。结果:全身骨平面显像与SPECT/CT骨断层显像对骨转移诊断结果的相异部分差异明显(优势性χ~2=23.000,P<0.001);SPECT/CT对骨转移的诊断特异度100.0%,诊断符合率98.1%,分别明显高于全身骨平面显像诊断特异度65.0%、诊断符合率80.4%,差异有统计学意义(P<0.05)。经SPECT/CT显像诊断,共发现性质待定病灶193个,诊断准确的骨转移病灶83个。骨转移灶主要为骨盆病灶(占50.6%)。结论:全身骨平面显像能够有效确定性质待定病灶,进一步开展SPECT/CT断层显像则能够显著提高前列腺癌骨转移的诊断准确率。

Objective To investigate the clinical value of 99mTc-MDP SPECT/CT whole body bone imaging in the diagnosis of bone metastasis of prostate cancer. Methods A total of 107 cases with prostate cancer were di- agnosed by SPECT whole body bone imaging from January 2013 to November 2016. SPECT/CT imaging of some ab- normal density collective focus found in whole body bone imaging were further carried out. Six months later, whole body bone imaging and SPECT/CT were made again for review. In all diagnosis above, 99mTc-MDP were selected as bone imaging agent. According to the results of follow-up visit clinical and imaging diagnosis, diagnostic perfor- mance indicators of whole body bone imaging and SPECT/CT were calculated. Results The different part of whole body bone imaging and SPECT/CT in the diagnosis of bone metastases was statistically significant （X2 = 23.000, P 〈 0.001 ）. The diagnosis specificity and coincidence rate of SPECT/CT for bone metastasis were 100.0% and 98.1% respectively and they were significantly higher than those of whole body bone imaging （65.0% and 80.4% respectively）. The differences were statistically significant （P 〈 0.05）. After SPECT/CT diagnosis, a total of 193 undetermined lesions were found and 83 lesions of these were final diagnosed of bone metastases. Pelvic lesions were most in bone metastases, accounting for 50.6%. Conclusion Whole body bone imaging can effectively determine the undetermined lesions, further SPECT/CT can significantly improve the diagnostic accuracy of prostate cancer bone metastasis.