应用增强CT评价地诺单抗治疗骨巨细胞瘤效果的临床研究

A clinical study of enhanced CT in evaluating the effects on denosumab treatment of bone giant cell tumors

目的探讨增强CT对地诺单抗治疗骨巨细胞瘤的效果。方法采用临床病例自身对照研究,根据入组条件选择我中心就诊的骨巨细胞瘤病例进行研究。选自2014年6月至2016年11月,共纳入18例。平均年龄为31.3(18~48)岁,男9例,女9例。病变位于骶骨或骨盆9例(骶骨7例,髂骨和坐骨各1例),位于四肢骨9例(胫骨3例,桡骨2例,肱骨、股骨、尺骨和腓骨各1例)。采用CT强化率变化评价地诺单抗用药后肿瘤血运变化。用药前接受骨病灶部位增强CT检查,地诺单抗治疗3个月再次接受增强CT检查。计算病灶部位的CT强化率(同一检查部位增强后的CT值/平扫的CT值)并比较用药前后强化率的变化。结果用药前和用药后病灶平均强化率分别为2.08和1.40,用药后的CT强化率显著降低(P=0.000)。用药前和用药后病灶平均平扫CT值分别为45.7和84.8,平扫CT值显著升高(P=0.038)。骶骨或骨盆病例用药后病灶强化率降低至用药前的60.8%(P=0.000)。四肢骨病例用后病灶强化率降低至用药前的76.6%(P=0.042)。骶骨或骨盆病例比四肢骨病例的强化率降低更为显著(P=0.024)。结论地诺单抗治疗后,CT显示骶骨、骨盆和四肢骨部位的骨巨细胞瘤病变内血运均显著降低,骶骨和骨盆部位肿瘤血运降低更为明显,同时病变内新生骨形成显著增加。

Objective To investigate enhanced CT in evaluating the effects on denosumab treatment of bone giant cell tumors. Methods Self-controlled study of clinical cases was used to select bone giant cell tumors in our center according to the inclusion criteria. From June 2014 to November 2016, a total of 18 patients were enrolled. The average age was 31.3 years（ range： 18-48 years）. There were 9 males and 9 females. The lesions were located in the sacrum or pelvis in 9 cases（ 7 cases of the sacrum, 1 case of the ilium, 1 case of the ischium）, in the extremities in 9 cases（ 3 cases of the tibia, 2 cases of the radius, 1 case of the humerus, 1 case of the femur, 1 case of the ulna and 1 case of the fibula）. The change of tumor blood supply was evaluated by CT enhancement rate. The bone lesions received enhanced CT examination before treatment. The enhanced CT was performed again after 3 months＇ treatment. The CT enhancement rate of the lesion site（ the ratio of enhanced CT value and unenhanced CT value of the same site） was calculated and the enhancement rates before and after treatment were compared. Results The average enhancement rates of lesions before and after treatment were 2.08 and 1.40 respectively, and the enhancement rate of CT after treatment was significantly lower（ P = 0.000）. The mean plain scan CT values before and after administration were 45.7 and 84.8 respectively, and plain scan CT values were significantly higher（ P = 0.038）. The enhancement rate in the sacral or pelvic cases after treatment decreased to 60.8%（ P = 0.000） of that before treatment. The enhancement rate in limbs cases decreased to 76.6%（ P = 0.042） of that before treatment. The enhancement rate of the sacral or pelvic cases decreased more significantly than that of extremities（ P = 0.024）. Conclusions CT shows that the blood supply of giant cell tumors in the sacrum, pelvis and extremities decreases significantly after denosumab treatment. The reduction of blood supply in the sacrum and pelvic is more obvious. The formation of new bone in the lesion increases significantly.