^(18)F-FDG PET/CT显像对肺癌骨转移、前列腺癌骨转移与多发性骨髓瘤的鉴别诊断

Differential diagnosis of bone metastasis of lung cancer,bone metastasis of prostate cancer,and multiple myeloma by^(18)F-FDG PET/CT imaging

目的探讨^(18)F-脱氧葡萄糖(^(18)F-FDG)正电子发射体层摄影(PET)/CT在肺癌骨转移、前列腺癌骨转移与多发性骨髓瘤(MM)鉴别诊断中的应用价值。方法横断面研究。纳入2020年11月—2022年11月西安交通大学第一附属医院均行^(18)F-FDG PET/CT检查的42例肺癌骨转移患者、30例前列腺癌骨转移患者和36例MM患者的临床资料,其中男78例、女30例,年龄33~87岁,分别纳入肺癌组、前列腺癌组和MM组。分析3组患者骨骼病灶的位置分布、骨质破坏类型和最大标准摄取值(SUVmax)的差异。结果3组患者年龄、性别比较,差异均有统计学意义(F=9.63、χ^(2)=17.17,P值均<0.001)。3组患者骨骼病灶部位70%以上累及肋骨、脊柱及骨盆,其次好发于四肢;3组患者骨骼病灶位于肋骨、骨盆、四肢、颅骨的差异均有统计学意义(P值均<0.05),位于脊柱和胸骨的差异均无统计学意义(P值均>0.05)。病灶分布位置组间比较显示:前列腺癌组骨转移灶分布于骨盆、四肢者分别为96.7%(29/30)、53.3%(16/30),均多于肺癌组的71.4%(30/42)、19.0%(8/42),差异均有统计学意义(P值均<0.05);MM组病灶位于肋骨者[100%(36/36)]多于前列腺癌组[70%(21/30)],位于骨盆者[72.2%(26/36)]少于前列腺癌组[96.7%(29/30)]、位于颅骨者[55.6%(20/36)]多于前列腺癌组和肺癌组[6.7%(2/30)和4.8%(2/42)],差异均有统计学意义(P值均<0.05)。3组患者骨质破坏类型总体比较的差异有统计学意义(χ^(2)=82.94,P<0.001):肺癌组和MM组患者骨骼病灶的骨质破坏均以溶骨性病变为主[81.0%(34/42)和94.4%(34/36)],成骨性病变较少[7.1%(3/42)和2.8%(1/36)],还有部分混合性病变[11.9%(5/42)和2.8%(1/36)];前列腺癌组患者则以成骨性病变为主[90.0%(27/30)]。在代谢特征方面,肺癌组、前列腺癌组和MM组的SUVmax水平依次由高到低(F=54.66,P<0.001)。结论^(18)F-FDG PET/CT有助于综合评价肺癌骨转移、前列腺癌骨转移和MM病灶的骨质结构和代谢特征,对它们具有较高的鉴别诊断价值。

Objective This study aims to explore the application value of^(18)F-fluorodeoxyglucose(^(18)F-FDG)positron emission computed tomography(PET)/CT in the differential diagnosis of bone metastasis of lung cancer,bone metastasis of prostate cancer,and multiple myeloma(MM).Methods The study was cross-sectional.The clinical data of 42 patients with bone metastasis of lung cancer,30 patients with bone metastasis of prostate cancer,and 36 patients with MM treated in the First Affiliated Hospital of Xi'an Jiaotong University from November 2020 to November 2022 were analyzed retrospectively,including 78 males and 30 females,aged 33 to 87 years.All patients underwent^(18)F-FDG PET/CT examination.They were divided into the lung cancer group,prostate cancer group,and MM group.Differences in^(18)F-FDG PET/CT examination results of lesion distribution,bone destruction,and maximum standardized uptake value(SUVmax)were analyzed.Results Significant differences in age and gender were observed among the three groups(F=9.63,χ^(2)=17.17,all P values<0.001).More than 70%of the bone lesions in the three groups involved the ribs,spine,and pelvis,followed by the limbs.There were significant differences in ribs,pelvis,limbs and skull among the three groups(all P values<0.05).There were no significant differences in spine and sternum(all P values>0.05).Comparison of lesion distribution between groups showed that:96.7%(29/30)and 53.3%(16/30)lesions occurred in the pelvis and limbs in the prostate cancer group,respectively,which were higher than those in the lung cancer group(71.4%[30/42]and 19.0%[8/42],respectively),with statistical significance(all P values<0.05).More lesions occurred in the ribs of MM group than in the prostate cancer group[100%(36/36)and 70%(21/30)],less lesions occurred in the pelvis(72.2%[26/30])than in the prostate cancer group(96.7%[29/30]),and more lesions occurred in the skull than in the prostate cancer group and lung cancer group(55.6%[20/36],6.7%[2/30],4.8%[2/42],respectively).All the differences were statistically significant(all P values<0.05).A significant difference in the type of bone destruction was observed among the three groups(χ^(2)=82.94,P<0.001).Bone destruction in the lung cancer group and MM group was primarily due to osteolytic lesions(81.0%[34/42]and 94.4%[34/36],respectively),and bone destruction caused by osteoblastic lesions was less observed(7.1%[3/42]and 2.8%[1/36],respectively).Some mixed lesions were also observed(11.9%[5/42]and 2.8%[1/36]).In the prostate cancer group,osteoblastic lesions were predominant(90.0%[27/30]).With regard to metabolic characteristics,SUVmax in the lung cancer group,prostate cancer group,and MM group showed a high-to-low order(F=54.66,P<0.001).Conclusion^(18)F-FDG PET/CT can be used to evaluate the bone structure and metabolic characteristics in lung cancer,prostate cancer,and MM,and has a high value in the differential diagnosis.