^(201)铊显像在骨与软组织良、恶性病变诊断中的应用

The application of ^(201) Tl chloride scintigraphy for malignant or benign bone and soft tissue lesions

目的探讨201Tl显像在骨与软组织病变定性诊断中的临床价值。方法对58例骨骼肌肉系统良、恶性病变进行201Tl显像,分别以注射后5min(早期)和2h(延迟期)显像,同时应用肉眼分析和半定量分析。其中6例骨肉瘤病例接受术前新辅助化疗前后均行201Tl定量显像,计算变化率(AR)并与肿瘤坏死率(TNR)进行对照研究。对其中43例骨病变病例与同期进行的99mTc-MDP骨显像结果进行比较。所有病例均经活检和手术后组织学证实,其中恶性骨肿瘤33例,良性骨病变10例,软组织肉瘤10例,软组织良性肿瘤5例。结果半定量分析43例恶性病变和15例良性病变的早期UR分别为2.856±1.121和1.304±0.324,两者的差异有显著性意义(t=5.259,P<0.001);两者的延迟期UR分别为2.261±0.769和1.100±0.139,其差异有显著性意义(t=5.786,P<0.001)。假设早期UR>1.735(2.856-1.121)且延迟期UR>1.492(2.261-0.769)为鉴别良、恶性的阈值,则敏感性为95.35%、特异性为93.33%、精确性为94.83%。6例骨肉瘤病例术前新辅助化疗前后201Tl显像显示变化率与肿瘤坏死率存在良好的相关性,对化疗敏感(TNR>90%)的5例病例化疗后201Tl显像示病灶摄取明显减少。结论201Tl显像的定量研究对骨与软组织病变良、恶性鉴别有重要的临床价值;本研究结果推荐早期UR>1.735,且延迟期UR>

Objective To investigate the clinical value of 201 Tl chloride scintigraphy in the differen-tial diagnosis of various musculoskeletal tumors.Methods 201 Tl chloride scintigraphy was performed to di ag-nose the malignancy of bone and soft tis sue tumors by visual and semi-quantitative assessment in58patients with43malignant lesions and15benign lesions.Planar images were obtained in the early phase5min after injection and the delayed phase120min.Six patients with osteosarco mas were evaluated by 201 Tl scintigra phy both pre-and post-chemotherapy,and tumor necrosis rate(TNR)were graded on the basis of percent age of tumor necrosis as defined histologically.And histological TNR was compared with the changes in the 201 Tl scintigraphic study.In all43of malignant and benign bony lesions 99m Tc-methylene-diphosphonate( 99m Tc-MDP )bone scan examination were accepted simultaneously.Results In comparison with benign tumors,malignant tumors showed longer retention and more increased uptake of the 201 Tl in the le sions on delayed images.Semi-quantitative assessment of the images changes was performed for the58cases.The early uptake ratio(UR)of 43malignant and15benign lesions was2.856±1.121and1.304±0.324re spectively,and the early UR of malignant lesions was significantly higher than that of benign le sions(t=5.259,P<0.001).The delayed UR of 43malignant and15benign lesions was2.261±0.769and1.100±0.139re spectively,the re-sults of malig nant and benign tumors demonstrated a significant difference statistically(t=5.786,P<0.001).If the tu mor with an early UR more than1.735(2.856-1.121)and delayed UR>1.492(2.261-0.769)was pre sumed to be malig nancy,the percentage of sensitivities,specificities,and accuracies of 201 Tl scintigraphy in differentiating malignant lesions from benign lesions was95.35%,93.33%,and94.83%respectively.In6cases of osteosarcomas with preoperative chemotherapy,201 Tl scintigraphic changes showed the concordance with TNR,planar images of 201 Tl of 5re sponders with TNR>90%showed decreased uptake ratio in the tumor le sions.Conclusion 201 Tl scintigra-phy is very useful for evalu ating the location and ex tent of tumor and differentiating malignant from benign bone and soft tissue tumors.The combination of early and delayed image is important for semi-quantitative assessment.We prefer the tumor with an early UR>1.735and delayed UR>1.492to be considered as malignancy.Serial 201 Tl scintigraphy,with quantitative analysis of alterations in 201 Tl uptake,may provide a potential quantitative and objective measure of the effect of preoperative chemothera py in osteosarcoma.[