SPECT/CT骨显像同机CT对骨外病变检出的增益价值

Clinical incremental values of extraosseous findings on CT during bone SPECT/CT imaging

目的 回顾性分析SPECT/CT骨显像上的同机CT扫描对骨外病变检出的临床增益价值.方法 回顾性分析2013年5月至2015年12月间843例行SPECT/CT显像的患者资料,其中男470例、女373例,年龄26~92岁.记录所有骨外意外发现,并参照C-RADS将这些意外发现分为E1、 E2、E3和E4级.采用χ2检验分析数据.结果 843例患者中,78.6%（663/843）的CT发现为正常或没有额外临床意义 （E1级和E2级）,21.4%（180/843）可能需要进一步检查评估（E3级和E4级）.在E4级骨外病变的检出率方面：有恶性肿瘤病史患者高于无恶性肿瘤病史患者[9.5%（59/622）和50%（11/221）; χ2=4.352,P〈0.05],性别之间差异无统计学意义[男8.5%（40/470）,女8.0%（30/373）; χ2=0.510,P〉0.05）],≥80岁者检出率最高（12.5%,16/128）.70例E4级骨外病变中,胸部肿块或结节最多见,其次为腹部和盆腔淋巴结肿大.结论 有重要临床意义的骨外意外发现在骨SPECT/CT显像上并不少见,系统解读同机CT图像并将重要的临床发现与临床医师沟通能够实现SPECT/CT检查的价值增益.

Objective To evaluate the prevalence of extraosseous findings on integrated CT images of routine SPECT/CT bone imaging and its clinical incremental values. Methods A total of 843 patients （470 males, 373 females, age range： 26-92 years） who underwent SPECT/CT bone imaging during May 2013 to December 2015 were enrolled in this retrospective study. A modified C-RADS was used to classify the extraosseous findings to E1, E2, E3 and E4. χ2 test was used for data analysis. Results The CT images in 78.6%（663/843） of patients were normal or with no additional clinical significance （E1 and E2）, and those in 21.4%（180/843） of patients might need further assessment （E3 and E4）. The rate of E4 extraosseous findings in patients with malignancy was higher than that in patients without malignancy： 9.5%（59/622） vs 5.0%（11/221）; χ2=4.352, P〈0.05. There was no significant difference of the rate between genders： 8.5%（40/470） in males vs 8.0%（30/373） in females; χ2=0.510, P〉0.05. With age increasing, the prevalence of E4 finding increased and the rate was the highest in the patients over 80 years old （125%, 16/128）. Seventy patients had E4 findings and chest masses and nodules were the most common, followed by the abdominal or pelvis lymph node enlargements. Conclusions Potentially important extraosseous findings are common on SPECT/CT. Systematic reviewing CT images and communicating the important unexpected findings to clinical physicians could enhance its clinical incremental values.