定量SPECT/CT（SUV<sub>max</sub>）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

doi:10.12122/j.issn.1674-4500.2021.03.04

定量SPECT/CT（SUV_max）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

杜芬^1,,
罗小毛²,
刘明¹,
李太创¹,
陈炜¹,
张廷杰¹,
刘琳¹,
黄德华¹,
卢洪辉¹,
梁颖^3, ,

1.
国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院核医学科，广东深圳 518116
2.
香港大学深圳医院核医学科，广东深圳 518000
3.
国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院PET/CT中心，北京 100021

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

计量
- 文章访问数: 1371
- HTML全文浏览量: 449
- PDF下载量: 123
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-29
- 刊出日期: 2021-05-20

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

1.
Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
2.
Department of Nuclear Medicine, Shenzhen Hospital of the University of Hong Kong, Shenzhen 518000, China
3.
PET/CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

摘要

摘要: 目的探讨定量SPECT/CT骨显像中最大标准摄取值（SUV_max）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SUV_max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SUV_max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+SUV_max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SUV_max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SUV_max≥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+SUV_max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 SUV_max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。
- 骨疾病 /
- 定量SPECT/CT /
- 诊断, 鉴别诊断 /
- 增益价值
Abstract: ObjectiveTo investigate the differential diagnosis value and incremental value of the maximum standard uptake value (SUV_max) of quantitative SPECT/CT imaging in benign and malignant bone lesions.MethodsFrom April to December in 2019, 124 patients with extraskeletal malignant tumors who underwent whole body bone scan (WBS) and quantitative SPECT/ CT were enrolled. A total of 294 abnormal tracer-positive concentration lesions was detected, and 92 normal vertebras were included as the control group. The differences of SUV_max among the benign, malignant, and control groups were analyzed. All lesions were further divided into two groups: The first group collected 46 cases totaling 108 lesions from April to July in 2019 and plotted ROC curve to obtain cut-off values of SUV_max. The second group prospectively collected 78 cases with 186 lesions from August to December 2019 and compared the diagnostic efficacy between SPECT/CT qualitative analysis and SPECT/CT qualitative+SUV_max quantitative analysis.ResultsUsing pathology and/or follow-up imaging (WBS, CT, MRI and/or PET/CT) for at least 12 months as the golden standard, 137 malignant, and 157 benign lesions were determined. The SUV_max of malignant lesions (27.29±14.44 g/mL) was significantly higher than benign lesions (16.28±10.21 g/mL, P=0.00) and the controls (6.91±1.41 g/mL, P=0.00). Using the cut-off value of SUV_max≥18.2 g/mL as the diagnostic criterion for malignant lesions obtained by the ROC curve in the first group, the sensitivities of SPECT/CT qualitative analysis and SPECT/CT qualitative + SUV_max quantitative analysis were 88.5% and 94.9%; specificities were 93.5%, and 93.5%; accuracies were 91.4% and 94.1%, respectively. The area under curve of ROC curve were 0.91(95% CI: 0.86-0.95) and 0.96(95% CI: 0.94-0.98), respectively, the differences between them were significant (P=0.01).ConclusionQuantitative SPECT/CT SUV_max has important clinical application and incremental value in the differential diagnosis of benign and malignant bone lesions.
- bone disease /
- quantitative SPECT/CT /
- differential diagnosis /
- incremental value

HTML全文

图 1 第1组中良恶性病灶间SUV_max ROC曲线

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

下载: 全尺寸图片幻灯片

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，SUV_max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.

下载: 全尺寸图片幻灯片

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

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

诊断方法	金标准		合计
诊断方法	恶性	良性	合计
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+ SUV_max定量分析
恶性	74	7	81
良性	4	101	105
合计	78	108	186
SUV_max：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；SUV_max定量分析针对对象为常规SPECT/CT定性分析2分组，根据SUV_max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SUV_max再分组.

下载: 导出CSV

参考文献(23)

[1]	Chang MC, Chen JH, Liang JA, et al. Meta-analysis: comparison of F-18 fluorodeoxyglucose-positron emission tomography and bone scintigraphy in the detection of bone metastasis in patients with lung cancer[J]. Acad Radiol, 2012, 19(3): 349-57. doi: 10.1016/j.acra.2011.10.018
[2]	Caglar M, Kupik O, Karabulut E, et al. Detection of bone metastases in breast cancer patients in the PET/CT era: Do we still need the bone scan?[J]. Revista Española De Med Nucl E Imagen Mol Engl Ed, 2016, 35(1): 3-11. http://www.sciencedirect.com/science/article/pii/S2253808915001354
[3]	Chen XL, Li Q, Cao L, et al. Diagnostic role of (99)Tc(m)-MDP SPECT/CT combined SPECT/MRI Multi modality imaging for early and atypical bone metastases[J]. Int J Clin Exp Med, 2014, 7 (12): 5336-41. http://europepmc.org/articles/PMC4307487/
[4]	Tomasi G, Turkheimer F, Aboagye E. Importance of quantification for the analysis of PET data in oncology: review of current methods and trends for the future[J]. Mol Imaging Biol, 2012, 14(2): 131-46. doi: 10.1007/s11307-011-0514-2
[5]	Lee WW, K-SPECT Group. Clinical applications of technetium- 99m quantitative single-photon emission computed tomography/computed tomography[J]. Nucl Med Mol Imaging, 2019, 53(3): 172-81. doi: 10.1007/s13139-019-00588-9
[6]	Kitajima K, Futani H, Fujiwara M, et al. Usefulness of quantitative bone single photon emission computed tomography/computed tomography for evaluating response to neoadjuvant chemotherapy in a patient with periosteal osteosarcoma[J]. Cureus, 2018, 10(11): e3655.
[7]	Kitajima K, Tsuchitani T, Takahashi Y, et al. Usefulness of quantitative bone single-photon emission computed tomography/computed tomography for evaluating the treatment response of bone metastasis in a lung cancer patient[J]. Case Rep Oncol, 2021, 14(1): 391-6. doi: 10.1159/000513907
[8]	赵祯, 李林, 李芳兰, 等. SPECT/CT同机融合显像鉴别诊断骨良恶性病灶的价值[J]. 四川大学学报: 医学版, 2008, 39(6): 1036-9. doi: 10.3969/j.issn.1672-173X.2008.06.040
[9]	Bailey DL, Willowson KP. An evidence-based review of quantitative SPECT imaging and potential clinical applications[J]. J Nucl Med, 2013, 54(1): 83-9. doi: 10.2967/jnumed.112.111476
[10]	Seret A, Nguyen D, Bernard C. Quantitative capabilities of four state-of-the-art SPECT-CT cameras[J]. EJNMMI Res, 2012, 2(1): 45. doi: 10.1186/2191-219X-2-45
[11]	Zhang YQ, Li BL, Yu HJ, et al. The value of skeletal standardized uptake values obtained by quantitative single-photon emission computed tomography-computed tomography in differential diagnosis of bone metastases[J]. Nucl Med Commun, 2020, 42(1): 63-7. http://www.ncbi.nlm.nih.gov/pubmed/33044406
[12]	Qi N, Meng Q, You Z, et al. Standardized Uptake Values of 99mTcMDP in Normal Vertebrae Assessed Using Quantitative SPECT/CT for Differentiation Diagnosis of Benign and Malignant Bone Lesions[J]. BMC Med Imaging, 2021, 21(1): 39. doi: 10.1186/s12880-021-00569-5
[13]	Arvola S, Jambor I, Kuisma A, et al. Comparison of standardized uptake values between 99mTc-HDP SPECT/CT and 18F-NaF PET/CT in bone metastases of breast and prostate cancer[J]. EJNMMI Res, 2019, 9(1): 6. doi: 10.1186/s13550-019-0475-z
[14]	Yamane T, Fukushima K, Shirotake S, et al. Test-retest repeatability of quantitative bone SPECT/CT[J]. Ann Nucl Med, 2021, 35(3): 338-46. doi: 10.1007/s12149-020-01568-2
[15]	Suh MS, Lee WW, Kim YK, et al. Maximum standardized uptake value of99mTc hydroxymethylene diphosphonate SPECT/CT for the evaluation of temporomandibular joint disorder[J]. Radiology, 2016, 280(3): 890-6. doi: 10.1148/radiol.2016152294
[16]	Tofuku K, Koga H, Komiya S. The diagnostic value of singlephoton emission computed tomography/computed tomography for severe sacroiliac joint dysfunction[J]. Eur Spine J, 2015, 24(4): 859- 63.
[17]	Kitajima K, Futani H, Tsuchitani T, et al. Quantitative bone SPECT/CT applications for cartilaginous bone neoplasms[J]. Hell J Nucl Med, 2020, 23(2): 133-7.
[18]	Riaz S, Bashir H, Niazi IK, et al. 99mTc MDP SPECT-CT-based modified mirels classification for evaluation of risk of fracture in skeletal metastasis: a pilot study[J]. Clin Nucl Med, 2018, 43(6): e180-3. doi: 10.1097/RLU.0000000000002057
[19]	Tabotta F, Jreige M, Schaefer N, et al. Quantitative bone SPECT/CT: high specificity for identification of prostate cancer bone metastases[J]. BMC Musculoskelet Disord, 2019, 20(1): 619. doi: 10.1186/s12891-019-3001-6
[20]	王海岩, 赵军, 孟庆元, 等. SPECT/CT融合骨显像中SUVmax测定对肿瘤患者肋骨转移灶的诊断价值[J]. 肿瘤影像学, 2017, 26(5): 318-21. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYX201705002.htm
[21]	Kaneta T, Ogawa M, Daisaki H, et al. SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate [J]. Am J Nucl Med Mol Imaging, 2016, 6(5): 262-8.
[22]	Lassus J, Tulikoura I, Konttinen YT, et al. Bone stress injuries of the lower extremity[J]. Acta Orthop Scand, 2002, 73(3): 359-68. doi: 10.1080/000164702320155392
[23]	邓群力, 莫逸, 刘康龙. 99mTc-亚甲基二膦酸盐骨显像评价乳腺癌骨转移的特征[J]. 分子影像学杂志, 2018, 41(3): 316-9. https://www.cnki.com.cn/Article/CJFDTOTAL-FZYX201803007.htm