骨外组织异常摄取99Tc^m-MDP对良恶性病变的鉴别诊断及其临床意义

Diagnostic value and clinical significance of abnormal uptake in extraosseous tissue for differentiating benign from malignant lesions

目的探讨骨外组织异常摄取99Tc^m-亚甲基二膦酸盐(MDP)在良、恶性病变中的规律及临床意义。方法回顾性分析2015年9月至2018年3月266例骨外组织异常摄取99Tc^m- MDP的患者(男132例,女134例,年龄:8~85岁),以显像后2周内的组织病理学结果、实验室及相关影像学检查(CT、MRI、超声、SPECT/CT或PET/CT显像)结果为最终诊断,分析异常99Tc^m -MDP摄取的规律。良、恶性病变组间比较采用χ2检验或Fisher确切概率法。结果266例骨外组织异常摄取99Tc^m-MDP的患者中恶性病变占87.2%(232/266),良性病变占12.8%(34/266),不同性别(χ^2=0.611,P>0.05)、年龄(P=0.584)、显影部位(P=0.118)组间良、恶性病变构成差异无统计学意义,而显影范围组的良、恶性病变构成差异有统计学意义(χ^2 =19.515,P<0.01),且单发局限病灶与单器官弥漫性病灶组间、单器官弥漫性病灶与多发病灶组间两两比较的差异有统计学意义(χ^2=8.959、19.325,均P<0.01)。结论骨外组织异常摄取99Tc^m- MDP时恶性病变的检出率较高,且病变良、恶性与病灶摄取范围有关。出现骨外异常摄取时应结合临床及相关检查综合分析,高度警惕恶性病灶的可能。

ObjectiveTo investigate the regularity and clinical significance of abnormal bone uptake of 99Tcm-methylene bisphosphonate (MDP) in benign and malignant lesions. MethodsA retrospective analysis was performed on 266 patients (132 males, 134 females, age range: 8-85 years) with abnormal uptake of 99Tcm-MDP in extraosseous tissues from September 2015 to March 2018. The final diagnosis of abnormal uptake was made according to the histopathology, laboratory and related imaging examination (CT, MRI, ultrasound, SPECT/CT or PET/CT imaging) results within 2 weeks after 99Tcm-MDP imaging. Regularity of abnormal 99Tcm-MDP uptake was comprehensively analyzed. Differences between benign and malignant groups were compared by χ^2 test or Fisher exact test. ResultsAbnormal 99Tcm-MDP uptake in extraosseous tissues in 232 patients (87.2%, 232/266) were confirmed as malignant lesions and those in 34 patients (12.8%, 34/266) were benign. There were no significant differences in gender (χ^2=0.611, P>0.05), age (P=0.584), and location (P=0.118) between benign and malignant lesions, but the involvement was significantly different (χ^2=19.515, P<0.05). There were significant differences between single focus and diffuse foci of single organ, diffuse foci of single organ and multiple foci groups (χ^2=8.959, 19.325, both P<0.01). ConclusionsThe detection rate of malignancy among foci with abnormal 99Tcm-MDP uptake in extraosseous tissues is high, and the malignancy may relate with the involvement of foci. When extraosseous uptake is found, clinical information and related examination results should be comprehensively analyzed and the malignancy should be taken into account.