^(18)F-NaF PET/CT显像诊断肾性骨病的价值

^(18)F⁃NaF PET/CT imaging in diagnosing renal osteodystrophy

目的:应用^(18)F-NaF PET/CT显像评估维持性血液透析(MHD)患者的骨显像特点,分析其与骨代谢标志物之间的相关性,探讨其对肾性骨病(ROD)的诊断价值。方法:回顾分析2020年5月至2022年11月于西南医科大学附属医院肾脏内科行^(18)F-NaF PET/CT显像的MHD伴ROD的20例患者资料。收集患者的临床基本信息及血钙、血磷、碱性磷酸酶(ALP)、全段甲状旁腺激素(iPTH)、总Ⅰ型胶原氨基端延长肽(t-P1NP)、N-MID骨钙素(N-MID OS)、β胶原特殊序列(β-CTX)等指标,通过^(18)F-NaF PET/CT骨显像检查,计算^(18)F-NaF的标准摄取值(SUV)。描述ROD骨显像的影像学特征并分析SUV与骨代谢标志物等生化指标之间的关系,从而了解骨^(18)F-NaF摄取与ROD的相关性。结果:70%ROD患者的^(18)F-NaF PET/CT图像显示全身骨骼多处显像剂异常浓聚,符合超级骨显像表现,颅骨及上、下颌骨显影明显表现为“黑颅征”或“狮面征”;肋骨和肋软骨连接处表现为对称性显影呈串珠样变;四肢骨表现为四肢长骨近端显像剂摄取弥漫性均匀增高或骨皮质增厚伴显像剂摄取增高,呈现出“双轨道征”征象。相关性分析显示腰椎SUV值与ALP呈正相关(r=0.493,P=0.027),股骨颈SUV值与iPTH(r=0.641,P=0.002)、t-P1NP(r=0.630,P=0.003)、β-CTX(r=0.513,P=0.021)均呈正相关。结论:^(18)F-NaF PET/CT显像能全面评估MHD患者的骨病变部位及范围。腰椎、股骨颈部位的^(18)F-NaF摄取与骨代谢标志物也具有较好的相关性,提示^(18)F-NaF PET/CT骨显像有望成为诊断及评估肾性骨病较好的影像学方法。

Objective:To evaluate the bone imaging characteristics of maintenance hemodialysis(MHD)patients with renal osteodystrophy(ROD)using^(18)F⁃NaF PET/CT imaging,and to analyze the correlation between^(18)F⁃NaF uptake and bone turnover markers,in order to explore the diagnostic value of^(18)F⁃NaF PET/CT imaging in ROD.Methodology:A retrospective study was conducted on 20 MHD patients with ROD who underwent^(18)F⁃NaF PET/CT imaging at the Department of Nephrology of the Affiliated Hospital of Southwest Medical University from May 2020 to November 2022.Clinical data and biochemical markers including calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),intact parathyroid hormone(iPTH),total type I collagen amino⁃terminal propeptide(t⁃P1NP),N⁃terminal mid⁃region osteocalcin(N⁃MID OS),andβ⁃carboxy⁃terminal telopeptide of type I collagen(β⁃CTX)were collected.Regions of interest(ROIs)were placed in the iliac crest,lumbar vertebrae,femoral neck,and standardized uptake value(SUV)of 18F⁃NaF was calculated.To describe the imaging features of ROD bone imaging and analyze the relationship between SUV and biochemical indicators,so as to understand the correlation between^(18)F⁃NaF uptake and ROD.Results:The images of 70%of MHD patients with ROD showed abnormal accumulation of imaging agents in multiple bones,consistent with the super bone scan.Skull and jaw bone imaging showed obvious“black skull”or“lion face”signs.The rib and costochondral junctions showed symmetric imaging with bead⁃like changes.The proximal ends of long bones showed diffuse and uniform increases in imaging agent uptake or cortical thickening with increased uptake,presenting a“double track sign.”The correlation analysis showed that the SUV values of the lumbar vertebrae were positively correlated with ALP(r=0.493,P<0.05),and the SUV values of the femoral neck were positively correlated with iPTH(r=0.641,P<0.01),t⁃P1NP(r=0.630,P<0.01),andβ⁃CTX(r=0.513,P<0.05).Conclusion:^(18)F⁃NaF PET/CT imaging can diagnose and comprehensively evaluate the location and extent of ROD in MHD patients.The good correlation between^(18)F⁃NaF uptake and bone turnover markers in the lumbar vertebrae and femoral neck suggests that^(18)F⁃NaF PET/CT bone imaging may become a promising non⁃invasive imaging method for the diagnosis and assessment of renal bone disease.