SPECT、CT和骨代谢标志物组合模型对肺癌骨转移的诊断价值

Diagnosis of Bone Metastasis of Lung Cancer by Using SPECT,CT and Bone Metabolism Markers Combined Model

目的采用SPECT、CT和骨代谢标志物血清碱性磷酸酶(ALP)、Ca^2+水平诊断肺癌骨转移,并评估多种组合模型的诊断价值。资料与方法选择206例经病理检查确诊的肺癌患者,检测其血清ALP、Ca^2+水平,然后进行SPECT全身骨扫描,并针对骨侵犯处进行CT扫描,判断有无骨质破坏;无骨质破坏者6个月后再次进行CT扫描,复查CT判断患者有无骨转移。并建立组合模型对肺癌骨转移进行评价。结果经CT初次扫描和复查结果证实,171例患者存在多发骨转移,35例未发生骨转移。SPECT诊断骨转移的敏感度为96.49%,特异度为45.71%,准确率为87.86%,阳性预测值为89.67%,阴性预测值为72.73%。骨转移组与无骨转移组患者血清ALP浓度[(113.63±32.72)U/ml比(88.47±25.29)U/ml]、血清Ca2+浓度[(2.24±0.26)mmol/L比(2.08±0.19)mmol/L]比较,差异有统计学意义(P=0.006、P=0.009)。应用组合模型(ALP、Ca^2+和SPECT)诊断肺癌骨转移的ROC曲线下面积为0.836,其敏感度、特异度、准确度、阳性预测值和阴性预测值分别为94.74%、71.43%、90.78%、94.19%和73.53%,其中特异度与SPECT独立诊断比较,差异有统计学意义(P=0.029)。结论应用血清ALP、Ca^2+和SPECT组合模型能显著提高肺癌骨转移的诊断效能,弥补SPECT特异度低的不足。

Purpose To use SPECT,CT and bone metabolism markers serum alkaline phosphatase(ALP)and Ca^2+ levels to diagnose lung cancer bone metastases,and to evaluate the diagnostic value of multiple combined models.Materials and Methods 206 patients with lung cancer diagnosed by pathological examination were selected,the serum ALP and Ca^2+ levels were detected,and then SPECT wholebody bone scan was performed,and CT scan was performed on the bone invasion to determine whether there was a bone destruction.CT scan was performed 6 months later in patients without bone destruction,and CT was reviewed to determine whether the patient had bone metastases.A combined model was established to evaluate lung cancer bone metastasis.Results The results of initial CT scan and reexamination confirmed that 171 patients had multiple bone metastases and 35 patients had no bone metastases.The sensitivity of SPECT for the diagnosis of bone metastases was 96.49%,the specificity was 45.71%,the accuracy was 87.86%,the positive predictive value was 89.67%,and the negative predictive value was 72.73%.Serum ALP concentration of patients with bone metastasis and no bone metastasis group[(113.63±32.72)U/ml vs.(88.47±25.29)U/ml],serum Ca^2+concentration[(2.24±0.26)mmol/L vs.(2.08±0.19)mmol/L]showed statistically significant difference(P=0.006,P=0.009).The area under the ROC curve of the combined model ALP,Ca^2+ and SPECT for the diagnosis of lung cancer bone metastasis was 0.836,the corresponding sensitivity,specificity,accuracy,positive predictive value and negative predictive values were 94.74%,71.43%,90.78%,94.19%and 73.53%,respectively;the specificity showed significant difference compared with the independent diagnosis of SPECT(P=0.029).Conclusion The combined model of serum ALP,serum Ca^2+ and SPECT can significantly improve the diagnostic efficiency of bone metastases from lung cancer and make up for the lack of SPECT's low specificity.