^(99m)Tc-MDP SPECT/CT显像在原发性骨肿瘤及肿瘤样病变良恶性鉴别诊断中的应用价值

The application value of ^(99m)Tc-MDP SPECT/CT bone imaging in the differential diagnosis of benign and malignant primary bone tumor and tumor-like disease

目的 探讨^(99m)Tc-MDP SPECT/CT显像对原发性骨肿瘤及肿瘤样病变良恶性鉴别诊断的应用价值。方法 回顾性分析2014年5月—2023年5月在康复大学青岛中心医院行^(99m)Tc-MDP全身骨显像和SPECT/CT显像的原发性骨肿瘤及肿瘤样病变患者75例,共128个病灶,所有病灶均经手术病理或活体组织检查或影像随诊获得最终诊断,对比同机SPECT、CT和SPECT/CT三种断层扫描对原发性骨肿瘤及肿瘤样病变的诊断效能。结果 128个病灶最终诊断良性病变88个,恶性病变40个,其中1例侵袭性骨巨细胞瘤,2例内生软骨瘤和1例骨软骨瘤局部恶变获得早期诊断。SPECT、CT和SPECT/CT显像对原发性骨肿瘤及肿瘤样病变良恶性的诊断灵敏度分别为70.6%(36/51)、87.2%(34/39)和97.4%(38/39),特异度分别为94.8%(73/77)、93.3%(83/89)和97.8%(87/89),阳性预测值分别为90.0%(36/40)、85.0%(34/40)和98.9%(87/89),阴性预测值分别为82.9%(73/88)、94.3%(83/88)和95.0%(38/40),准确度分别为85.2%(109/128),91.4%(117/128)和97.7%(125/128)。SPECT/CT显像与SPECT比较灵敏度和准确度明显提高(P<0.05),和CT比较阳性预测值明显提高(P<0.05)。结论 SPECT/CT显像在原发性骨肿瘤及肿瘤样病变良恶性鉴别诊断中有较高的诊断效能,对侵袭性的原发性骨肿瘤以及部分良性骨肿瘤及肿瘤样病变局部恶变的早期诊断有很大优势,具有重要的临床应用价值。

Objective To investigate the application value of SPECT/CT bone imaging in the differential diagnosis of benign and malignant primary bone tumor and tumor-like disease.Methods The retrospective analysis was performed on 75 patients,a total of 128 lesions,with primary bone tumor and tumor-like disease who underwent ^(99m)Tc-MDP whole bone scan and SPECT/C T bone imaging in our hospital from May 2014 to May 2023.They were finally diagnosed by surgical pathology or biopsies or follow-up.The diagnostic efficacy of the three tomography of SPECT,CT and SPECT/CT on the same machine were analyzed.Results Among 128 lesions,88 benign and 40 malignant.One case of invasive giant cell tumor of bone and the local malignancy of two cases of enchondroma and one case of osteochondroma were diagnosed early.Using SPECT、CT and SPECT/CT imaging for the differential diagnosis of benign and malignant primary bone tumor and tumor-like disease of 128 lesions,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 70.6%(36/51)vs 87.2%(34/39)vs 97.4%(38/39),94.8%(73/77)vs 93.3%(83/89)vs 97.8%(87/89),90.0%(36/40)vs 85.0%(34/40)vs 98.9%(87/88),82.9%(73/88)vs 94.3%(83/88)vs 95.0%(38/40),85.2%(109/128)vs 91.4%(117/128)vs 97.7%(125/128),respectively.The value of SPECT/CT imaging in diagnosing primary bone tumor and tumor-like disease was higher than SPECT and CT,The former sensitivityand accuracy(P<0.05),the latter positive predictive value(P<0.05),the pairwise comparison were statistically significant.Conclusion SPECT/CT imaging has higher diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value in the differential diagnosis of benign and malignant primary bone tumor and tumor-like disease.Especially,the early diagnosis of invasive primary bone tumors and local malignant transformation of benign bone tumor or bone tumor-like lesions has great advantages.^(99m)Tc-MDP SPECT/CT imaging has important clinical application value.