SPECT全身骨显像对多发性骨髓瘤和前列腺癌骨转移瘤的鉴别诊断价值分析

Analysis of Value of SPECT Whole Body Bone Scanning in Differential Diagnosis of Huppert's Disease and Osseous Metastasis of Prostatic Cancer

目的分析SPECT全身骨显像对前列腺癌骨转移瘤和多发性骨髓瘤的鉴别诊断价值。方法随机选定该院50例前列腺癌骨转移瘤患者作为观察组,50例多发性骨髓瘤患者作为对照组,2014年1月—2018年4月为研究时段,均进行SPECT全身骨显像诊断,以病理诊断作为金标准,计算两种疾病的诊断符合率,并分析病灶的分布情况以及核素的分布特点。结果观察组、对照组SPECT全身骨显像检查结果,与病理诊断结果比较,诊断符合率分别是96.00%、98.00%,差异无统计学意义(χ~2=2.040 8,1.010 1 P=0.153 1,0.314 9)。50例前列腺癌骨转移瘤患者,病灶分布位置:48例骨盆,占96.00%;43例股骨,占86.00%;41例脊柱,占82.00%;38例胸骨,占76.00%;39例肋骨,占78.00%;40例颅骨,占80.00%。632个病灶均是异常放射性核素浓聚,形态、大小不一,多为不规则、片状、条状、点状浓集灶,主要分布在患者骨盆、肋骨、脊柱等部位,其中有3例是超级影像。50例多发性骨髓瘤患者,病灶分布位置:10例肩关节,占20.00%;16例骨盆,占32.00%;20例颅骨,占40.00%;26例脊柱,占52.00%;50例肋骨,占100.00%。以颅骨、骨盆、脊柱、胸骨多发类圆形或者点状浓聚为特征,267个病灶是放射性核素浓集,16个病灶是放射性核素缺损或者稀疏,3例颅骨核素聚集,以帽状聚集,10例锁骨、颅骨处核素分布表现为串珠样,8例四肢大关节表现为对称性核素分布浓集。结论 SPECT全身骨显像可对前列腺癌骨转移瘤以及多发性骨髓瘤的病灶分布情况以及核素分布特点做出准确的分析,对两种疾病具有较高的鉴别价值,效果显著,值得借鉴。

Objective To analyze the value of SPECT whole body bone scanning in differential diagnosis of Huppert's disease and osseous metastasis of prostatic cancer. Methods 50 cases of patients with osseous metastasis of prostatic cancer diagnosed in our hospital were randomly selected as the observation group from January 2014 to April, and 50 cases of patients with Huppert's disease at the same period in our hospital were selected as the control group, and all patients were for SPECT whole body bone scanning, and the diagnosis coincidence rate of the two disease were calculated according to the golden standards of pathological diagnosis, and the distribution of lesions and distribution features of nuclides were analyzed. Results The examination results showed that the diagnosis coincidence rates of SPECT whole body bone scanning and pathological diagnosis was respectively 96.00%, 98.00%, and the difference was statistically significant (χ^2=2.0408, 1.0101 P=0.3149, 0.1531), of 50 cases with osseous metastasis of prostatic cancer, 48 cases in pelvis, accounting for 96.00%; 43 cases in femur, accounting for 86.00%, 41 cases in spine, accounting for 82.00%, 38 cases in sternum, accounting for 76.00%, 39 cases in ribs, accounting for 78.00%, 40 cases in skull, accounting for 80.00%, and 632 lesions were anomalous radionuclide concentration, mainly distributed in the pelvis, rib and spine, including 3 cases were the superscan. Of 50 cases with Huppert's disease, 10 cases in the shoulder joint, accounting for 20.00%; 16 cases in the pelvis, accounting for 32.00%, 20 cases in skull, accounting for 40.00%, 26 cases in spine, accounting for 52.00%, 50 cases in ribs, accounting for 100.00%, and 267 lesions were the radionuclide concentration, 16 lesions were the radionuclide deficiency or sparsity, 3 cases were the cranial radionuclide aggregation, gathered as the shape of cap, 10 cases were distributed in clavicle and skull, showing the string-of-beads, and the large joints of extremities of 8 cases were symmetry. Conclusion The SPECT whole body bone scanning can make an accurate analysis of lesion distribution and nuclide distribution features of Huppert's disease and osseous metastasis of prostatic cancer, which is of higher differential diagnosis value, and the effect is obvious, and it is worth reference.