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定量SPECT/CT(SUVmax)在骨良恶性病灶中的鉴别诊断及增益价值

杜芬 罗小毛 刘明 李太创 陈炜 张廷杰 刘琳 黄德华 卢洪辉 梁颖

杜芬, 罗小毛, 刘明, 李太创, 陈炜, 张廷杰, 刘琳, 黄德华, 卢洪辉, 梁颖. 定量SPECT/CT(SUVmax)在骨良恶性病灶中的鉴别诊断及增益价值[J]. 分子影像学杂志, 2021, 44(3): 435-440. doi: 10.12122/j.issn.1674-4500.2021.03.04
引用本文: 杜芬, 罗小毛, 刘明, 李太创, 陈炜, 张廷杰, 刘琳, 黄德华, 卢洪辉, 梁颖. 定量SPECT/CT(SUVmax)在骨良恶性病灶中的鉴别诊断及增益价值[J]. 分子影像学杂志, 2021, 44(3): 435-440. doi: 10.12122/j.issn.1674-4500.2021.03.04
Fen DU, Xiaomao LUO, Ming LIU, Taichuang LI, Wei CHEN, Tingjie ZHANG, Lin LIU, Dehua HUANG, Honghui LU, Ying LIANG. Differential diagnosis value and incremental value of quantitative SPECT/CT (SUVmax) fusion imaging in benign and malignant bone lesions[J]. Journal of Molecular Imaging, 2021, 44(3): 435-440. doi: 10.12122/j.issn.1674-4500.2021.03.04
Citation: Fen DU, Xiaomao LUO, Ming LIU, Taichuang LI, Wei CHEN, Tingjie ZHANG, Lin LIU, Dehua HUANG, Honghui LU, Ying LIANG. Differential diagnosis value and incremental value of quantitative SPECT/CT (SUVmax) fusion imaging in benign and malignant bone lesions[J]. Journal of Molecular Imaging, 2021, 44(3): 435-440. doi: 10.12122/j.issn.1674-4500.2021.03.04

定量SPECT/CT(SUVmax)在骨良恶性病灶中的鉴别诊断及增益价值

doi: 10.12122/j.issn.1674-4500.2021.03.04
详细信息
    作者简介:

    杜芬,硕士,住院医师,E-mail: 496221685@qq.com

    通讯作者:

    梁颖,博士,主任医师,E-mail: liangy_2000@sina.com

Differential diagnosis value and incremental value of quantitative SPECT/CT (SUVmax) fusion imaging in benign and malignant bone lesions

  • 摘要: 目的探讨定量SPECT/CT骨显像中最大标准摄取值(SUVmax)对骨良恶性病灶的鉴别诊断及潜在增益价值。方法回顾性分析2019年4 ~12月经病理证实为非骨原发恶性肿瘤患者行骨显像检查,并因异常放射性浓聚灶行SPECT/CT检查及定量分析者124例,共发现病灶294个,同时选取92个正常椎体为对照组,比较良、恶性病灶、对照组间SUVmax的差异性。将病例分为两组:第1组收集2019年4 ~7月46例检查者共108个病灶,绘制ROC曲线得到SUVmax诊断恶性病灶的界值,第2组收集2019年8 ~12月78例检查者共186个病灶,比较常规SPECT/CT定性分析与常规SPECT/CT定性+SUVmax定量分析的诊断效能。结果以病理和/或12月及以上的影像学随访(WBS、CT、MRI、PET/CT)为判断金标准,诊断恶性病灶137例,良性病灶157例;恶性病灶、良性病灶和对照组的SUVmax分别为27.29±14.44、16.28±10.21和6.91±1.41 g/mL(P < 0.01)。通过第1组数据绘制ROC曲线得到SUVmax≥18.2 g/mL为诊断恶性病灶界值,在第2组中常规SPECT/CT定性分析、常规SPECT/CT定性+SUVmax定量分析的诊断敏感度分别为88.5%和94.9%,特异性为93.5%和93.5%,准确度为91.4%和94.1%,ROC曲线下面积分别为0.91(95% CI:0.86~0.95)和0.96(95%CI:0.94~0.98)(P=0.01)。结论定量SPECT/CT SUVmax在骨良恶性病灶鉴别诊断中具有重要临床应用价值,且存在一定的增益价值。

     

  • 图  1  第1组中良恶性病灶间SUVmax ROC曲线

    Figure  1.  The ROC curve of the SUVmax between malignant and benign lesions in the first group.

    图  2  男性,45岁,诊断肺癌2月

    2019-05-30行全身骨扫描(A前位、B后位)及颈部SPECT/CT检查,示颈5、6椎体放射性异常浓聚,颈5椎体骨质密度较相邻椎体稍减低但未见骨质破坏(C~F),颈6椎体骨质密度正常(E~F),评分2分,SUVmax分别为32.12 g/mL、27.60 g/mL(均 > 18.7g/mL)。相继于2019-06-11核磁增强扫描亦提示颈5、6椎体转移(G),后行克唑替尼靶向治疗3月,并于2019年9月5日复查核磁示病灶强化程度减低(H).

    Figure  2.  45-year-old male patient with lung cancer.

    表  1  第2组中SPECT/CT定性分析与SPECT/CT定性+SUVmax定量分析的诊断效能

    Table  1.   The diagnostic efficacies of SPECT/CT qualitative analysis, and SPECT/CT qualitative + SUVmax analysis of the second group

    诊断方法 金标准 合计
    恶性 良性
    常规SPECT/CT定性分析
      恶性 69 7 76
      良性 9 101 110
      合计 78 108 186
    常规SPECT/CT定性+ SUVmax定量分析
      恶性 74 7 81
      良性 4 101 105
      合计 78 108 186
    SUVmax:最大标准摄取值;此表中常规SPECT/CT定性分析为3分者为恶性组,1分+2分者为良性组;SUVmax定量分析针对对象为常规SPECT/CT定性分析2分组,根据SUVmax再分组,≥18.2 g/mL者为恶性,反之为良性;对于已明确诊断的1分及3分组将不根据SUVmax再分组.
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  • 收稿日期:  2021-04-29
  • 刊出日期:  2021-05-20

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