【摘要】 目的探讨¹⁸F-FDG PET/CT,^99mTc-MDP全身骨显像（BS）及BS联合CT这三种方法对肺癌骨转移诊断价值的比较。方法回顾性分析2014年1月²016年8月间行¹⁸F-FDG PET/CT及BS检查并经病理证实的56例肺癌患者,将BS与¹⁸F-FDG PET/CT同机CT图像进行联合诊断,以病理及临床随访为诊断依据,比较BS、BS联合CT及¹⁸F-FDG PET/CT对肺癌骨转移的诊断价值。数据分析采用χ²检验,P﹤0.05为差异有统计学意义。结果 56例患者中骨转移28例共138处骨转移灶。基于患者,¹⁸F-FDG PET/CT（96.4%及94.6%）与BS联合CT（89.3%及91.1%）诊断肺癌骨转移的特异性及准确性均高于BS（60.7%及75.0%）（均P<0.01与均P<0.05）,¹⁸F-FDG PET/CT（92.9%）与BS（89.3%）灵敏度差异无统计学意义。¹⁸F-FDG PET/CT与BS联合CT之间差异均无统计学意义。基于骨转移灶,¹⁸F-FDG PET/CT对骨转移灶的检出率（92.0%）高于BS联合CT（79.0%）（X²=9.473,P<0.01）,BS联合CT高于BS（68.1%）（X²=4.191,P<0.05）。¹⁸F-FDG PET/CT对CT无形态异常（骨髓转移）及溶骨性转移灶的检出率高于BS联合CT（X²=16.261及15.300,均P<0.01）,BS联合CT对溶骨性转移灶的检出率高于BS（X²=6.711,P<0.01）,BS对成骨性转移灶的检出率高于¹⁸F-FDG PET/CT（X²=8.892,P<0.01）。¹⁸F-FDG PET/CT更容易发现位于胸椎、骶椎、骨盆及股骨的转移灶。结论¹⁸F-FDG PET/CT与BS联合CT诊断肺癌骨转移的价值优于BS,¹⁸F-FDG PET/CT能更早发现BS联合CT无法检出的骨髓及小的溶骨性转移灶。更多还原

【Abstract】 Objective To investigate the diagnostic value of¹⁸F-FDG PET/CT,compared with^99mTc-MDP bone scintigraphy or combined CT for the detection of bone metastases in patients with lung cancer. Methods We retrospectively analyzed 56 patients（ 33 men,23 women,median age 60. 0 years）. All specimens conrmed by the pathology underwent both¹⁸F-FDG PET/CT and bone scintigraphy from January 2014 to August 2016. We combined BS with CT which was used for¹⁸F-FDG PET/CT and joint pathology and clinical follow-up diagnosis to compare the diagnostic value of bone scintigraphy,or combined CT with¹⁸FFDG PET/CT. Chi-square test was used for comparing results of bone metastasis by this three methods. P < 0. 05 was considered statistically significant. Results Of the 56 patients,28 patients with 138 metastatic bone lesions were diagnosed. Based on patients,the specificity and accuracy for¹⁸F-FDG PET/CT（ 96. 4% and 94. 6%） and BS combined CT（ 89. 3% and 91. 1%）were higher than BS（ 60. 7% and 75. 0%） in diagnosisof bone metastases of lung cancer（ all P < 0. 05）,but the sensitivity of¹⁸F-FDG PET/CT（ 92. 9%） and BS（ 89. 3%） had no statistical significance. The difference between¹⁸F-FDG PET/CT and BS combined CT had no statistical significance. Based on metastatic bone lesions,the relevance ratio of bone metastases by¹⁸F-FDG PET/CT（ 92. 0%） were higher than BS combined CT（ 79. 0%）（ X²= 9. 473,P < 0. 01）. Meantime,the relevance ratio of bone metastases by BS combined CT（ 79. 0%） was higher than BS（ 68. 1%）（ X²= 4. 191,P < 0. 05）. The relevance ratio of no abnormal morphology（ bone marrow metastases） and osteolytic metastases by¹⁸F-FDG PET/CT were higher than BS combined CT（ X²= 16. 261 and 15. 300,P < 0. 01）. The relevance ratio of osteolytic metastases by BS combined CT was higher than BS（ X²=6. 711,P < 0. 01）. The relevance ratio of osteoblastic metastases by BS was higher than¹⁸F-FDG PET/CT（ X²= 8. 892,P <0. 01）. We found¹⁸F-FDG PET/CT was easier to find metastases located in thoracic vertebra,sacralvertebra,pelvis and femur.Conclusion The diagnostic value of¹⁸F-FDG PET/CT and BS combined CT was better than BS alone for the detection of bone metastases in patients with lung cancer.¹⁸F-FDG PET/CT could earlierly find bone marrow metastases and small osteolytic metastases than BS combined CT.更多还原