【摘要】 目的探讨⁹⁹锝-亚甲基二膦酸盐(^99mTc-MDP)全身骨显像作为肺癌术前常规检查的临床价值。方法回顾性分析华中科技大学同济医学院附属同济医院病理确诊的249例原发性肺癌患者术前^99mTc-MDP全身骨显像病灶分布特点,计算其检出率、敏感度、特异度、准确度、阳性预测值及阴性预测值。结果 1249例患者中有101例全身骨显像结果异常,45例证实为骨转移,6例骨显像未见异常但X线、CT、MRI或PET-CT检查提示骨转移。其检出率为18.07%（45/249）、灵敏度为88.24%（45/51）、特异度为71.72%（142/198）、准确度为75.10%（187/249）、阳性预测值为44.55%（45/101）、阴性预测值为95.95%（142/148）。245例阳性骨显像共发现骨转移部位109个,以胸部骨36例（33.03%）最常见,其次是脊柱29例（26.61%）、骨盆22例（20.18%）、四肢骨15例（13.76%）及颅骨7例（6.42%）。以多发转移（30/45）为主,单处及2处放射性分布异常者15例,均经CT、MRI检查证实骨转移。3不同病理类型骨转移发生率为:腺癌22.90%（30/131）,鳞癌11.69%（9/77）、小细胞癌和其他类型肺癌14.63%（6/41）。经统计分析发现,腺癌与鳞癌之间骨转移发生率差异有统计学意义（χ²=4.002,P<0.05）。结论 ^99mTc-MDP全身骨显像因其灵敏度高、可早期发现全身多处骨转移病灶而作为探测骨转移瘤的首选检查方法。对肺癌患者常规行^99mTc-MDP全身骨显像,不仅有利于临床分期,而且可以避免不必要的手术,为患者制定更为合理的治疗方案。更多还原

【Abstract】 Objective To investigate the clinical value of ^99mTc-MDP whole-body bone scan（WBS）as a routine preoperative examination of lung cancer. Methods Distribution characteristics of the lesions on preoperative ^99mTc-MDP WBS were collected from 249 patients who were pathologically confirmed to have lung cancer in Tongji Hospital.The diagnostic sensitivity,specificity,and accuracy,and the positive and negative predictive value were evaluated.Results 1Among the 249 patients,101were found to have abnormal bone images on ^99mTc-MDP WBS preoperatively.Forty-five patients were confirmed to develop bone metastases,and 6negative cases were proved by X-ray,CT,MRI or PET-CT to have bone metastases.The detection rate of bone metastases was 18.07%（45/249）and the sensitivity,specificity,accuracy,positive and negative predictive value were88.24%（45/51）,71.72%（142/198）,75.10%（187/249）,44.55%（45/101）and 95.95%（142/198）,respectively.2A total of109 bone metastatic lesions were found in the 45 positive cases.Most lesions were located in the thoracic bones（n=36,33.03%）which was followed by spine（n=29,26.61%）,pelvis（n=22,20.18%）,extremities（n=15,13.76%）,and skulls（n=7,6.42%）.Thirty cases were multiple metastases,and 15 cases had less than two metastases.3The incidence of bone metastases of lung cancer with different pathological types was as follows:adenocarcinoma 22.90%（30/131）,squamous carcinoma11.69%（9/77）,small cell carcinoma and other types of lung cancer 14.63%（6/41）.There was significantly difference in the incidence of bone metastasis between adenocarcinoma and squamous carcinoma（χ²=4.002,P<0.05）.Conclusion ^99mTc-MDP WBS is the examination of choice for bone metastases,with the advantages of high sensitive and early detection of multiple bone metastatic lesions.^99mTc-MDP WBS conducted routinely in lung cancer patients not only contributes to clinical staging but also protects patients from unnecessary operations,and therefore provides more reasonable therapeutic strategies for patients with lung cancer.更多还原