^(18)F-FDG PET/CT显像对多发性骨髓瘤与原因不明溶骨性转移瘤的鉴别诊断价值

Differential diagnostic value of^(18)F-FDG PET/CT in multiple myeloma and unknown osteolytic metastasis

目的探讨^(18)F-FDG PET/CT对多发性骨髓瘤(MM)与原因不明溶骨性转移瘤(UOM)的鉴别诊断价值。方法回顾性分析2017年6月至2020年3月间在同济大学附属第十人民医院行^(18)F-FDG PET/CT检查的43例患者[男29例,女14例,年龄(61.5±12.9)岁]资料。所有患者全身多发溶骨性骨质破坏且未发现明显骨外恶性肿瘤,病理诊断MM 20例[男13例、女7例,年龄(61.1±12.2)岁],UOM 23例[男16例、女7例,年龄(61.4±13.9)岁]。将全身骨骼分为颅骨、脊柱、肋骨、骨盆、胸骨、锁骨、肩胛骨、四肢长骨,分析每个骨骼部位^(18)F-FDG PET/CT图像中病灶横截面长径、有无骨皮质破坏、SUV_(max)以及显像剂分布是否均匀。采用两独立样本t检验和Mann-Whitney U检验分析数据。结果UOM组患者在锁骨部位未见明显病灶;其余7个骨骼部位中,MM和UOM组患者均以脊柱、骨盆为最好发部位[41.30%(299/724)和49.37%(117/237)、24.45%(177/724)和26.58%(63/237)]。MM组颅骨、脊柱、肋骨、骨盆、四肢长骨部位病灶长径均明显小于UOM组[分别为5.45(4.30,8.06)与(13.89±11.66)mm、6.15(3.89,10.06)与11.48(7.73,16.90)mm、7.01(4.59,10.56)与(24.61±16.22)mm、8.20(5.14,13.71)与(21.12±13.31)mm、(8.48±5.75)与(19.13±14.26)mm;z值:-8.88~-2.52,t=-2.76,P<0.001或P<0.05];MM组上述部位及肩胛骨病灶SUV_(max)也明显小于UOM组[分别为1.50(1.00,2.20)与17.15±11.40、2.60(2.00,4.10)与8.20(5.65,11.90)、2.30(1.40,5.28)与10.58±5.52、2.50(1.80,3.90)与9.34±6.01、3.08±2.41与11.38±6.38、2.45(1.50,4.43)与6.90(4.63,17.80);z值:-13.87~-2.41,t=-4.85,P<0.001或P<0.05]。在颅骨、脊柱、肋骨、骨盆、肩胛骨、四肢长骨部位的病灶,MM组以显像剂弥漫性分布多见,而UOM组则以不均匀分布多见;在颅骨、脊柱、肋骨部位的病灶,MM组表现为无骨皮质破坏,而UOM组则表现为骨皮质破坏。结论综合比较^(18)F-FDG PET/CT图像中病灶骨皮质破坏情况、SUV_(max)、病灶长径、显像剂分布,可以帮助医师在获得病理结果前初步鉴别MM与UOM。

Objective To investigate the differential diagnostic value of^(18)F-FDG PET/CT in multiple myeloma(MM)and unknown osteolytic metastasis(UOM).Methods A retrospective study was performed on^(18)F-FDG PET/CT imaging of 43 patients(29 males,14 females,age:(61.5±12.9)years)with multiple bone destructions and without extraosseous primary malignant tumor between June 2017 and March 2020 in Tenth People′s Hospital of Tongji University.Through follow-up,20 patients(13 males,7 females,age:(61.1±12.2)years)were pathologically confirmed as MM and 23 patients(16 males,7 females,age:(61.4±13.9)years)were pathologically confirmed as UOM.The whole body skeleton was categorized to 8 sites including skull,spine,ribs,pelvis,sternum,clavicle,scapula and limb bone.The differences of the cross-sectional length of the lesion,cortical bone damage,SUV_(max)and the distribution of imaging agent were compared between the two groups in different parts.Independent-sample t test and Mann-Whitney U test were used to analyze data.Results The UOM group was invisible on clavicles,and spine and pelvis were the most predilection sites in both MM and UOM groups(spine:41.30%(299/724)and 49.37%(117/237);pelvis:24.45%(177/724)and 26.58%(63/237)).The cross-sectional length of lesions in the skull,spine,ribs,pelvis and limb bone in MM group were significantly shorter than those in UOM group(5.45(4.30,8.06)vs(13.89±11.66)mm,6.15(3.89,10.06)vs 11.48(7.73,16.90)mm,7.01(4.59,10.56)vs(24.61±16.22)mm,8.20(5.14,13.71)vs(21.12±13.31)mm,(8.48±5.75)vs(19.13±14.26)mm;z values:from-8.88 to-2.52,t=-2.76,P<0.001 or P<0.05)and SUV_(max)of above lesions and scapula in MM group were significantly lower than those in UOM group(1.50(1.00,2.20)vs 17.15±11.40,2.60(2.00,4.10)vs 8.20(5.65,11.90),2.30(1.40,5.28)vs 10.58±5.52,2.50(1.80,3.90)vs 9.34±6.01,3.08±2.41 vs 11.38±6.38,2.45(1.50,4.43)vs 6.90(4.63,17.80);z values:from-13.87 to-2.41,t=-4.85,P<0.001 or P<0.05).The imaging agents in lesions on the skull,spine,ribs,pelvis,scapula and limb bone were more evenly distributed in MM group,while the imaging agents in lesions were more unevenly distributed in UOM group.On the skull,spine and ribs sites,the MM group was more likely to show no cortical bone damage;however,the UOM group showed cortical bone damage in the above sites.Conclusion It is helpful for doctors to distinguish MM and UOM by comparing the cross-sectional length of the lesion,cortical bone damage,SUV_(max)and the distribution of imaging agent in^(18)F-FDG PET/CT imaging before getting pathologic results.