【作者】 郭睿；

【导师】 晋建华；

【作者基本信息】 山西医科大学 ， 影像医学与核医学， 2007， 硕士

【摘要】 目的:⁹⁹Tc^m-亚甲基二膦酸（MDP）骨显像是评价恶性肿瘤患者有无骨转移的重要方法,其灵敏度虽高,但特异性较低。许多⁹⁹Tc^m-MDP骨显像阳性的患者,病灶定性比较困难。本研究目的是应用⁹⁹Tc^m-枸缘酸（Citrate）显像与⁹⁹Tc^m-MDP显像相结合,探讨其在骨转移癌和良性骨病鉴别诊断中的价值。方法:对⁹⁹Tc^m-MDP显像阳性的44例患者（107个病灶）,在⁹⁹Tc^m-MDP骨显像后2-7天行⁹⁹Tc^m-Citrate显像。静脉注射740-925MBq ⁹⁹Tc^m-Citrate后2～3h行全身显像,并在病灶部位行局部平面或断层显像。所有骨骼病灶性质的诊断最终均由病理学、影像学、临床随访等方法得到证实。据此将病变分为良性骨病、骨转移癌两组。骨转移癌患者伴有良性骨病灶时也同时计为良性骨病组。（1）根据采集图像划定感兴趣区（ROI）,进行半定量分析并比较两组病变之间下述两项指标有无差异:每个病灶与健侧的⁹⁹Tc^m-MDP摄取比,每个病灶与健侧的⁹⁹Tc^m-citrate/⁹⁹Tc^m-MDP值（RUR）之比。如果上述指标有差异,则根据相关比值,在两组患者中用受试者操作者特性曲线（ROC曲线）的方法来决定界值点（取此界值点时良、恶性病变鉴别诊断的灵敏度、特异性和准确度最高）,并以此界值点为界值,计算⁹⁹Tc^m-Citrate显像在良、恶性病变诊断中的灵敏度、特异性、准确度。（2）由2名以上经验丰富的核医学医师用四级评分法对显像结果进行定性分析,计算⁹⁹Tc^m-Citrate显像在良、恶性病变诊断中的灵敏度、特异性、准确度。结果:44例（107个病灶）患者中有5例（15个病灶）最终未能作出骨骼病灶的确定诊断,故排除在外。因此纳入本研究范围的共39例（92个病灶）,其中良性组44个病灶,恶性组48个病灶。（1）半定量分析:良、恶性两组病灶之间⁹⁹Tc^m-MDp摄取比分别为1.76±0.30和1.80±0.32,（t=0.61,P=0.545）,差别无统计学意义;两组之间的RUR值分别为0.49±0.19和0.70±0.20;（t=5.39,P＜0.01）,差别有统计学意义。故根据RUR值,在两组患者中划ROC曲线来决定区分良、恶骨质病变的界值,取0.66时,灵敏度、特异性和准确度最高（分别为66.7%,87.4%,76.6%）。（2）定性分析:48个骨转移癌病灶,⁹⁹Tc^m-Citrate显像在相应部位检出35个。44个良性骨病灶,⁹⁹Tc^m-Citrate显像在相应部位检出5个病灶。本组病例⁹⁹Tc^m-Citrate显像诊断骨转移癌病灶灵敏度为72.92%,诊断良性骨病灶的特异性为88.64%,准确度为80.43%。结论:⁹⁹Tc^m-Citrate与⁹⁹Tc^m-MDP显像相结合进行半定量分析或定性分析,对于骨显像阳性病灶进行鉴别诊断可提供一定参考价值。更多还原

【Abstract】 Objectives:For the evaluation of bone metastases in patients with cancer,⁹⁹Tc^m-MDP bone scintigraphy is an important tool,but some limitations exist.One of these is the differential diagnosis of malignant and benign bone disease.The aim of this study was to differentiate them using ⁹⁹Tc^m-Citrate and ⁹⁹Tc^m-MDP scintigraphy.Methods:44 patients（107 lesions）with malignant or benign bone disease were studied,for which the results of ⁹⁹Tc^m-MDP scintigraphy were positive.⁹⁹Tc^m-Citrate scintigraphy was performed 2-7 days after ⁹⁹Tc^m-MDP scintigraphy,at a dose of 740～925MBq.Acquisition protocol:static,2-3hr,planar or SPECT images when required.Each lesion was confirmed as benign or malignant,which was independently verified,using conventional techniques （histopathology,X-ray,CT,MRI,bone scintigraphy and clinical follow up）,so they were divided into two subgroups,malignant group and benign group.Benign lesions in patients with malignant disease were also evaluated and are included in benign group.（1）The ⁹⁹Tc^m-MDP uptake and ⁹⁹Tc^m-Citrate to ⁹⁹Tc^m-MDP RUR（lesion-to-background radioisotope uptake ratio） for a lesion was calculated.The critical point was determined using receive operating characteristic curve（ROC curve）,in both groups of patients,then calculated the highest sensitivity,specificity and accuracy.（2）Two expericnced nuclear medicine physicians evaluated the images as positive or negative by visual analysis,then calculated the sensitivity,specificity and accuracy.Results:Of these,5 patients（15 lesions）were excluded because of the the difficulty to make a final diagnosis.Ultimately,92 lesions met all the criteria,including 44 benign bone disease and 48 malignant bone disease.（1）Uptaking of ⁹⁹Tc^m-MDP in the two groups is of the same（1.76±0.30 vs.1.80±0.32,t=0.61,P=0.545）,while the mean ⁹⁹Tc^m-citrate/⁹⁹Tc^m-MDP RUR in the benign group was significantly lower than the mean in the malignant group（0.49±0.19 vs.0.70±0.20,t=5.39,P＜0.01）.The critical point was determined using ROC curve in both groups of patients.The one with the highest sensitivity and specificity,0.66,was designated the critical point,where the sensitivity was 66.7%for metastases bone disease,the specificity was 87.4%for benign bone disease,and the accuracy was 76.6%.（2）For the diagnosis of bone lesions by visual analysis,the sensitivity,specificity and accuracy of this technique were 72.92%, 88.64%and 80.43%,respectively. Conclusions:⁹⁹Tc^m-Citrate scintigraphy combined with ⁹⁹Tc^m-MDP scintigraphy is a promising method to differentiate malignant from benign bone lesions seen as areas of increased activity on ⁹⁹Tc^m-MDP bone scintigraphy.更多还原