SPECT骨显像联合CT和MRI在恶性肿瘤骨转移诊断中的临床价值

Clinical value of SPECT imaging combined with CT and MRI in the diagnosis of bone metastasis

目的探讨单光子发射计算机断层成像术(SPECT)骨显像联合CT和MRI在恶性肿瘤骨转移诊断中的应用价值。方法选取2016年3月至2019年3月间北京市房山区第一医院收治的80例恶性肿瘤并发骨转移患者,均采用SPECT骨显像、CT和MRI检查,分析原发肿瘤骨转移灶区域分布及三种检测方式诊断骨转移瘤的效能。结果无明显骨痛症状者46例,有明显骨痛症状者34例。骨转移瘤发生部位依次为脊柱、肋骨、骨盆、胸部、四肢和颅骨。脊柱转移瘤中,好发部位依次为胸椎、腰椎、骶椎和颈椎。SPECT与CT相同扫描野内诊断出464处病灶,SPECT检出429处(92.5%),CT检出率361处(77.8%),两者比较,差异有统计学意义(P<0.05),在相同扫描野之外SPECT另检出143处病灶。SPECT与MRI相同扫描野内诊断出321处病灶,SPECT检出307处(95.6%),MRI检出265处(82.6%),两者比较,差异有统计学意义(P<0.05),在相同扫描野之外SPECT另检出286处病灶。CT与MRI相同扫描野内诊断出259处病灶,CT检出185处(71.4%),MRI检出248处(95.8%),两者比较,差异有统计学意义(P<0.05)。SPECT骨显像联合CT和MRI检查的灵敏度、特异性和准确度均高于单独使用SPECT骨显像、CT或MRI,差异均有统计学意义(均P<0.05)。结论SPECT可作为可疑骨转移瘤的首选筛查手段,联合CT和MRI能明确恶性肿瘤骨转移的区域分布情况,提高诊断的灵敏度、特异性及准确度,有较高的临床价值。

Objective To explore the significance of single-photon emission computerized tomography(SPECT),Computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of bone metastasis from malignant tumors.Methods Eighty patients with bone metastasis from malignant tumors who admitted to First Hospital of Fangshan District were selected from March 2016 to March 2019.They underwent bone scan with SPECT imaging,CT and MRI separately.The distribution of bone metastasis from primary tumors as well as efficacy of the above three detection methods for bone metastasis was analyzed.Results Forty-six patients did not have obvious symptoms of bone pain and 34 patients had obvious symptoms of bone pain.Bone metastasis mainly occurred in spine followed by rib,pelvic,chest,limbs and skull.For the spinal metastasis,thoracic was most frequently invaded followed by lumbar,sacral and cervical.A total of 464 lesions were detected by SPECT and CT in the same scanning field,with SPECT detection rate of 92.5%(429/464)and CT detection rate of 77.8%(361/464)(P<0.05).In addition,143 lesions were detected by SPECT beyond the same scanning field.A total of 321 lesions were detected by SPECT and MRI in the same scanning field,with SPECT detection rate of 95.6%(307/321)and MRI detection rate of 82.6%(265/321)(P<0.05),and another 286 lesions were detected by SPECT beyond the same scanning field.In all,259 lesions were detected by CT and MRI scans in the wild same scanning field.The detection rate was 71.4%(185/259)for CT,and 95.7%(248/259)for MRI(P<0.05).The sensitivity,specificity and accuracy of SPECT imaging combined with CT and MRI were higher than single SPECT imaging,CT and MRI(P<0.05).Conclusion SPECT may be the preferred screening modality for suspected bone metastases,and when combined with CT and MRI,it can clarify the regional distribution of bone metastasis from malignant tumors and improve the sensitivity,specificity and accuracy of diagnosis with high clinical significance.