18F-NaF PET/CT与99mTc-MDP SPECT诊断恶性肿瘤骨转移的Meta分析

Comparison of 18F-NaF PET/CT and 99mTc-MDP SPECT in diagnosis of bone metastasis: a Meta-analysis

目的系统性回顾并对比分析氟18-氟化钠(^18F-NaF PET/CT)与锝99m-亚甲基二磷酸盐(^99mTc-MDP SPECT)在恶性肿瘤骨转移中的诊断价值。方法系统检索Pubmed、Embase、Scopus、Cochrane Library、Web of Science、Sinomed、CNKI、万方医学网及维普自2000年1月至2018年12月发表^18F-NaF PET/CT及^99mTc-MDP SPECT诊断骨转移的文献。对纳入文献进行筛选,并基于PRISMA指南应用QUADAS-2对文献进行质量评价;提取相关数据,应用STATA 12软件合并纳入文献的敏感性、特异性、阳性预测值、阴性预测值,并绘制受试者工作曲线。结果最终纳入10项研究,共742例患者。基于患者水平,^18F-NaF PET/CT诊断骨转移的诊断敏感性、特异性、阳性预测值、阴性预测值、曲线下面积及95%置信区间分别是0.99(0.89~1.00)、0.97(0.74~1.00)、29.3(3.1~277.2)、0.01(0.00~0.12)、1.00(0.99~1.00);^99mTc-MDP SPECT诊断骨转移的诊断敏感性、特异性、阳性预测值、阴性预测值、曲线下面积分别是0.86(0.76~0.93)、0.82(0.69~0.90)、4.7(2.8~7.9)、0.17(0.10~0.29)、0.91(0.88~0.93)。基于病灶水平,^18F-NaF PET/CT诊断骨转移的诊断敏感性、特异性、阳性预测值、阴性预测值、曲线下面积分别是0.87(0.54~0.98)、0.89(0.62~0.98)、8.2(1.6~41.7)、0.14(0.03~0.75)、0.94(0.92~0.96);^99mTc-MDP SPECT诊断骨转移的诊断敏感性、特异性、阳性预测值、阴性预测值、曲线下面积分别是0.77(0.35~0.95)、0.87(0.70~0.95)、5.9(1.6~20.8)、0.27(0.06~1.19)、0.90(0.87~0.92)。结论^99mTc-MDP全身骨显像仍可作为最常用的成骨性骨转移筛查手段,而18 F-NaF PET/CT在骨转移诊断方面表现出更高的诊断价值,其敏感性、特异性均较^99mTc-MDP SPECT显像明显增加。^18F-NaF作为骨特异性显像剂,与肿瘤特异性显像剂联合应用,将有更为广阔的应用前景。

Objective To systematically review and compare the diagnostic performance of 18 F-NaF PET/CT and 99m Tc-MDP SPECT in bone metastasis.Methods A comprehensive literature search of Pubmed、Embase、Scopus、Cochrane Library、Web of Science、Sinomed、CNKI、Wanfang Med Online and Weipu was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis(PRISMA)guidelines published from January 2000 to December 2018.The results were analyzed with STATA 12 software.Subgroup analysis was performed by stratification based on study design and geographic area.Results Ten studies with 742 patients were selected.Based on patients,the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and AUC of ^18F-NaF PET/CT and ^99mTc-MDP SPECT were 0.99(0.89~1.00)and 0.86(0.76~0.93),0.97(0.74~1.00)and 0.82(0.69~0.90),29.3(3.1~277.2)and 4.7(2.8~7.9),0.01(0.00~0.12)and 0.17(0.10~0.29),1.00(0.99~1.00)and 0.91(0.88~0.93).Based on lesions,the pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and AUC of ^18F-NaF PET/CT and ^99mTc-MDP SPECT were 0.87(0.54~0.98)and 0.77(0.35~0.95),0.89(0.62~0.98)and 0.87(0.70~0.95),8.2(1.6~41.7)and 5.9(1.6~20.8),0.14(0.03~0.75)and 0.27(0.06~1.19),0.94(0.92~0.96)and 0.90(0.87~0.92).Conclusion The conventional bone scan remains the most common available screening method for osteoblastic bone metastases.While,compared with 99m Tc-MDP SPECT,^18F-NaF PET/CT has greater sensitivity,specificity,and offering excellent advantage in bone metastases.^18F-NaF as a bone-specific imaging agent,combine with tumor-specific radionuclide will be more useful for assessment of skeletal metastatic diseases.