Diagnostic value of whole-body bone imaging and SPECT/CT in bone destruction caused by Talaromyces marneffei
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摘要:
目的 探讨全身骨显像与SPECT/CT在马尔尼菲篮状菌感染骨破坏中的诊断价值及显像特征分析。 方法 回顾性分析我院2016年6月~2021年6月于核医学科行全身骨显像及SEPCT/CT断层融合显像的马尔尼菲篮状菌患者47例，其中男25例，女22例，年龄17~72岁，中位年龄51岁。比较全身骨显像、SPECT/CT对马尔尼菲篮状菌骨破坏的诊断效能，并探讨马尔尼菲篮状菌骨破坏的显像特征。 结果 全身骨显像，SPECT/CT断层融合显像对马尔尼菲篮状菌骨破坏诊断符合率比较，差异有统计学意义（P < 0.05）。全身骨平面显像对骨破坏的诊断敏感度为84.4%，特异性为100%，诊断符合率85.1%；SPECT/CT对TM骨破坏的诊断敏感度为97.8%，特异性为100%，诊断符合率98.9%。马尔尼菲篮状菌骨破坏主要侵犯中轴骨，并伴有全身多个位置受累，四肢骨及颅骨为其相对特异性的侵犯位置。 结论 全身骨显像可以一次性观察全身病灶，在病变的早期即可检出骨质代谢的异常活跃，SPECT/CT诊断符合率较高，二者联合对马尔尼菲篮状菌骨破坏具有很好的应用价值。 Abstract:Objective To explore the diagnostic value and imaging characteristics of whole-body bone imaging and SPECT/CT in bone destruction caused by Talaromyces marneffei. Methods We retrospectively analyzed 47 patients with Talaromyces marneffei who underwent whole-body bone imaging and SPECT/CT tomographic fusion imaging in the Department of Nuclear Medicine in our hospital from June 2016 to June 2021, including 25 males and 22 females, aged from 17 to 72 years old, with a median age of 51 years. We compared the diagnostic efficacy of whole-body bone imaging and SPECT/CT in bone destruction, and discussed the imaging characteristics of bone destruction. Results There was a significant difference in the coincidence rate of whole-body bone imaging and SPECT/CT tomographic fusion imaging in the diagnosis of bone destruction caused by Talaromyces marneffei (P < 0.05). The sensitivity of whole-body bone imaging in the diagnosis of bone destruction was 84.4%, the specificity was 100%, and the diagnostic coincidence rate was 85.1%. The diagnostic sensitivity of SPECT/CT for TM bone destruction was 97.8%, the specificity was 100%, and the diagnostic compliance rate was 98.9%. Bone destruction of Talaromyces marneffei mainly affects the axial bones and is associated with the involvement of several locations throughout the body, with the bones of the extremities and the skull being the relatively specific sites of invasion. Conclusion Whole-body bone imaging can observe the whole-body focus at one time, and the abnormal activity of bone metabolism can be detected in the early stage of the lesion. The coincidence rate of SPECT/CT diagnosis is high. The combination of SPECT/CT has a high diagnostic yield and is of good use in the case of bone destruction caused by Talaromyces marneffei. -
Key words:
- whole-body bone imaging /
- SPECT/CT /
- Talaromyces marneffei /
- bone destruction
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图 1 一例24岁女性患者的SPECT/CT断层融合显像及全身骨显像
A: SPECT/CT断层融合显像示左侧髂骨见的小片状显像剂分布异常浓聚影, 其靠近骶髂关节处见显像剂分布稀疏, 呈现中间缺损周边浓聚的特点. 融合CT示左侧髂骨明显骨质破坏（白色箭头）, 其上方见条索状软组织影，密度不均（黑色箭头）; B: 全身骨显像示左侧顶骨、右侧第3前肋、左侧髂骨见片状显像剂异常浓聚影.
Figure 1. SPECT/CT tomographic fusion imaging and whole-body bone imaging of a 24-year-old female patient
表 1 全身骨显像与SPECT/CT断层融合显像对TM感染骨破坏的诊断结果对比
Table 1. Comparison of diagnostic results between whole-body bone imaging and SPECT/CT tomographic fusion imaging in TM infected bone destruction[n (%)]
全身骨显像 SPECT/CT断层融合显像 合计 骨破坏 无骨破坏 骨破坏 38 (80.9) 0 (0.0) 38 (80.9) 无骨破坏 6 (12.8) 3 (6.4) 9 (19.1) 合计 44 (93.6) 3 (6.4) 47 (100.0) χ2=4.167, P=0.041. 
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表 2 全身骨显像与SPECT/CT断层融合显像对TM感染骨破坏的诊断效能对比
Table 2. Diagnostic efficiency of whole-body bone scintigraphy compared with SPECT/CT tomographic fusion imaging in TM infected bone destruction (%)
检测方法 敏感度 特异性 诊断符合率 全身骨显像 84.4 100 85.1 SPECT/CT断层融合显像 97.8 100 98.9
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表 3 TM感染骨破坏病灶分布特点
Table 3. Characteristics of distribution of bone destruction lesions in TM infection
骨破坏部位 例数(n) 病灶数(个) 肋骨 35 285 脊柱 29 88 颅骨 32 69 股骨 28 50 骨盆 25 48 胸骨 15 34 肩关节 17 32 肱骨 15 25 膝关节 10 21 胫骨 10 20 合计 - 672
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