18F-NaF PET/CT对多发性骨髓瘤的诊断价值及其影像学特征的回顾性研究

A retrospective study of diagnostic value and imaging features of 18F⁃NaF PET/CT in multiple myeloma

目的探究18F-NaF正电子发射计算机断层显像(PET/CT)诊断多发性骨髓瘤(multiple myeloma,MM)的影像特征及应用价值。方法回顾性分析53例临床疑诊为MM患者,均在7 d内完成99mTc-MDP单光子发射计算机断层成像(SPECT/CT)及18F-NaF PET/CT检查,最终均通过病理等检查确诊或排除MM。分析两种骨显像的影像特征,对比两种显像方法对于MM诊断效能有无差异。结果 53例中,42例确诊MM,11例排除MM。99mTc-MDP SPECT/CT与18F-NaF PET/CT诊断MM灵敏度分别为88.1%(37/42)、97.62%(41/42),特异度均为81.82%(9/11),准确度分别为86.79%(46/53)、92.45%(49/53)。18F-NaF PET/CT的灵敏度高于99mTc-MDP SPECT/CT,其差异有统计学意义(χ2=3.896,P <0.05);特异性相同;准确度差异无统计学意义(χ2=1.504,P>0.05)。42例MM患者99mTc-MDP SPECT/CT、18F-NaF PET/CT发现病灶数分别为238、351,其差异有统计学意义(χ2=20.441,P <0.001)。MM病灶放射性分布特征:脊柱骨粗横条形或细线形显像剂摄取增高;胸廓骨"散弹"状显像剂摄取增高;骨盆骨团片状或结节状显像剂摄取增高;颅骨占"花斑"状显像剂摄取增高;四肢骨点状或竖条状显像剂摄取增高。结论在诊断MM中,与99mTc-MDP SPECT/CT相比,18F-NaF PET/CT能检出更多患者、发现更多病灶、图像质量更佳,能更大程度地满足临床需要。

Objective To investigate the diagnostic value and imaging features of 18F⁃NaF PET/CT in multiple myeloma(MM).Methods Fifty⁃three patients suspected of MM were collected and retrospectively ana⁃lyzed.All patients took 99mTc⁃MDP SPECT/CT and 18F⁃NaF PET/CT examination within a week and all cases were confirmed or excluded MM by pathology.The diagnostic efficiency of MM using two different imaging methods were compared.Distribution characteristics of imaging agents were analyzed.Results In the 53 cases,42 were diag⁃nosed as MM and 11 were excluded from MM.The sensitivity of 99mTc⁃MDP SPECT/CT and 18F⁃NaF PET for diagnos⁃ing MM was 88.1%(37/42)and 97.62%(41/42)respectively.They have the same specificity 81.82%(9/11)and the accuracy was 86.79%(46/53)and 92.45%(49/53)respectively.The sensitivity of 18F⁃NaF PET/CT was higher than that of 99mTc⁃MDP SPECT/CT(χ2=3.896,P<0.05),but the difference in accuracy was not statistically significant(χ2=1.504,P>0.05).The number of lesions found in 99mTc⁃MDP SPECT/CT and 18F⁃NaF PET/CT of 42 patients with MM was 238 and 351 respectively(χ2=20.441,P<0.001).Distribution characteristics of radio⁃activity in MM lesions:the tracer uptake of spine was thick stripe or thin line increased;the tracer uptake of ribs was scattering punctuate increased;the tracer uptake of pelvis was clumps or nodular increased;the tracer uptake of skull was“Speckle”shape;the tracer uptake of limbs was punctate or vertical stripes.Conclusion In the diag⁃nosis of MM,18F⁃NaF PET/CT is easier to detect lesions than 99mTc⁃MDP SPECT/CT.The image quality is better,which can meet the clinical needs to a greater extent.