晚期非小细胞肺癌骨转移18F-FDG PET/CT影像学特征和预测价值

Radiologic Characteristic and Predictive Value of Bone Metastases in Advanced Non-small Cell Lung Cancer for 18F-FDG PET/CT

目的探讨18F-氟脱氧葡萄糖(18F-fluorodeoxy glucose,18F-FDG)正电子发射断层扫描/计算机断层扫描(positron emission tomography/computed tomography,PET/CT)在评估非小细胞肺癌(non-small cell lung cancer,NSCLC)伴单发骨18F-FDG代谢异常患者发生骨转移风险的相关性。方法本研究回顾性分析118例诊断为NSCLC并伴有单发骨18F-FDG代谢异常患者临床资料。通过PET/CT、脑磁共振成像(magnetic resonance imaging,MRI)和胸部增强CT检查均无证据表明有其他脏器转移,分析骨病变最大标准摄取值(standardized uptake value,SUVmax)及CT影像学特征、原发肿瘤SUVmax、临床肿瘤TNM分期。结果经病理活检、MRI特征性表现及临床随访证实骨转移患者33例(27.97%),良性病变者85例(72.03%)。骨SUVmax截断值为4.3,表现出良好的诊断性能(灵敏度81.82%,特异度84.70%,准确度83.90%)。当骨病灶PET/CT的SUVmax≤2,骨边缘硬化或骨折可明确诊断为良性;当SUVmax>10,软组织肿块或骨质破坏可明确诊断为转移病变。当骨病灶的SUVmax>4.3及溶骨性改变,NSCLC的SUVmax>6.4,T2及以上分期,N1及以上分期易发生转移,上述表现≤1个的病变可明确诊断为良性,上述表现≥4个的病变可明确诊断为转移。37例患者具有2~3种上述特征的病例中,良性骨病灶27例,转移性骨病灶10例。结论结合骨病变和PET/CT特征,可对NSCLC患者发生骨转移风险进行精准预测,提高诊断效率。

Objective To investigate the ability of18F-fluorodeoxy glucose(18F-FDG)positron emission tomography/computed tomography(PET/CT)in evaluating the risk correlation of bone metastasis in non-small cell lung cancer(NSCLC)patients with single bone18F-FDG metabolic abnormalities.Methods A total of 118 patients diagnosed with NSCLC with single bone18F-FDG metabolic abnormalities was retrospectively analyzed.There was no evidence of metastasis in other organs by PET/CT,magnetic resonance imaging(MRI)and chest enhancal CT.Standardized uptake value(SUVmax),CT imaging features,SUVmax of primary tumor and TNM stage of clinical tumor were analyzed.Results Bone metastases were confirmed in 33 cases(27.97%)and benign lesions in 85 cases(72.03%)by pathological biopsy,MRI characteristics and clinical follow-up.The truncation value of bone SUVmax was 4.3,showing good diagnostic performance(sensitivity 81.82%,specificity 84.70%and accuracy 83.90%).When SUVmax of bone lesion PET/CT≤2,bone marginal sclerosis or fracture could be definitively diagnosed as benign;when SUVmax>10,soft tissue mass or bone destruction could be definitively diagnosed as metastatic disease.When SUVmax of bone lesion>4.3 and lytic changed,SUVmax of NSCLC>6.4.The stages T2 and above as well as N1 and above were prone to metastasis.Lesions with one or fewer of these manifestations were clearly diagnosed as benign,while lesions with four or more of these manifestations were clearly diagnosed as metastatic.Among the 37 cases with 2 to 3 features,27 were benign and 10 were metastatic.Conclusion Combined with bone lesions and PET/CT features,NSCLC can accurately predict the risk of bone metastases in these patients and improve diagnostic efficiency.