Standardized uptake value in quantitative SPECT/CT can diagnose metastatic bone tumors
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摘要:
目的 探讨基于最大期望值重建算法定量SPECT/CT中的标准化摄取值（SUV）在转移性骨肿瘤中的诊断价值。 方法 回顾性分析2022年3~5月在广西医科大学附属第一医院核医学科行定量SPECT/CT骨扫描的75例患者，共勾画87个骨高代谢病灶的SUV，同时勾画骨代谢正常患者的脊柱SUV作为对照组（43个脊柱椎体）。测定良性病灶、恶性病灶、对照组的最大标准化摄取值（SUVmax）、平均标准化摄取值（SUVmean）、最小标准化摄取值（SUVmin）。组间比较采用非参数检验，使用ROC曲线获得最佳阈值。 结果 以病理和/或6~12月及以上的影像学随访为判断的最终标准，诊断骨转移组病灶48个，良性病变组病灶39个，骨转移组SUV分别为SUVmax 30.15（20.75，45.43）g/mL、SUVmean 16.65（11.75，23.10）g/mL、SUVmin 11.6（8.40，15.27）g/mL，良性病变组SUV分别为SUVmax 13.5（10.4，17.5）g/mL、SUVmean 8.22（5.89，9.56）g/mL、SUVmin 5.83（2.63，6.89）g/mL，对照组SUV分别为SUVmax 7.47±1.99 g/mL、SUVmean 3.74±0.68 g/mL、SUVmin 1.06±0.46 g/mL，骨转移组SUV高于良性病变组和对照组（P＜0.001）；ROC曲线分析显示，SUVmax、SUVmean、SUVmin曲线下的面积分别为0.876、0.912、0.901，SUVmax截断值为26.6 g/mL时，其特异性为100%，敏感度为64.6%，当SUVmin值取8.1 g/mL时，其敏感度、特异性分别为81.2%与89.7%，SUVmean截断值为11.5 g/mL，敏感度、特异性分别为77.1%、92.3%；联合定量SPECT/CT骨融合显像+SUVmean值诊断的检出率大于常规SPECT/CT骨融合图像（χ2=11.576，P=0.001），两者的诊断符合率分别为75.86%、94.25%。 结论 定量SPECT/CT中的SUV在骨良恶性病灶的鉴别诊断中具有一定的临床应用价值，补充了对肿瘤骨转移灶和骨良性病灶的定性分析；定量SPECT/CT骨融合显像+SUVmean在诊断肿瘤骨转移的准确性高于常规SPECT/CT骨融合显像。 Abstract:Objective To investigate the diagnostic value of standardized uptake value (SUV) of quantitative SPECT/CT based on the maximum expectation reconstruction algorithm in metastatic bone tumors. Methods A total of 75 patients who underwent quantitative SPECT/CT bone scanning in the Department of Nuclear Medicine of our hospital from March to May 2022 were retrospectively analyzed. The SUV of 87 bone hypermetabolism lesions was delineated, and the SUV of the spine of patients with normal bone metabolism was delineated as the control group (43 spinal vertebrae). The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and minimum standardized uptake value (SUVmin) of benign lesions, malignant lesions and control group were measured. A non-parametric test was used for comparison between groups, and ROC curve was used to obtain the best threshold value. Results According to pathology and/or imaging follow-up of 6 to 12 months or more, 48 lesions were diagnosed as bone metastasis and 39 lesions as benign lesions. SUVmax 30.15(20.75, 45.43) g/mL, SUVmean 16.65(11.75, 23.10) g/mL, SUVmin 11.6(8.40, 15.27) g/mL in the bone metastasis group, and SUVmax 13.5(10.4, 15.27) g/mL, SUVmean 8.22(5.89, 9.56) g/mL, SUVmin 5.83(2.63, 6.89) g/mL in the benign group, while the SUVmax 7.47±1.99 g/mL, SUVmean 3.74 ± 0.68 g/mL, SUVmin 1.06 ± 0.46 g/mL in the control group, respectively. The SUV of the bone metastasis group was significantly higher than that of the benign lesion group and the control group (P < 0.001). ROC curve analysis showed that the area under the curve of SUVmax, SUVmean and SUVmin were 0.876, 0.912 and 0.901, respectively. When the cut-off value of SUVmax was 26.6 g/mL, the specificity was 100% and the sensitivity was 64.6%. When the cut-off value of SUVmin was 8.1 g/mL, the sensitivity and specificity were 81.2% and 89.7%, respectively. The cutoff value of SUVmean was 11.5 g/mL, sensitivity and specificity were 77.1% and 92.3%, respectively. The detection rate of combined quantitative SPECT/CT bone fusion imaging and SUVmean value was higher than that of conventional SPECT/CT bone fusion imaging (χ2=11.576, P=0.001), and the diagnostic coincidence rate was 75.86% and 94.25%, respectively. Conclusion The SUV of quantitative SPECT/CT has a certain clinical application value in the differential diagnosis of benign and malignant bone lesions, which complements the qualitative analysis of bone metastases and benign bone lesions. Quantitative SPECT/CT bone fusion imaging +SUVmean is more accurate than conventional SPECT/CT bone fusion imaging in the diagnosis of tumor bone metastasis. -
Key words:
- quantitative /
- SPECT/CT /
- standardized uptake value /
- metastatic bone tumor /
- bone fusion imaging
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图 1 骨高代谢病变SUV勾画
Figure 1. Delineation of SUV of bone hypermetabolic lesions. A 41-year-old male patient presented with a right neck mass for more than 2 months. 99mTc-MDP whole-body bone scan revealed abnormal concentration lesions in the right ilium and the right ischium, and SPECT/CT scan showed fuzzy boundaries, irregular low-density shadow and high radionuclide uptake in the right ilium and the right ischium. The images were post-processed by workstation software (Q.Valumetrix MI Evolution for Bone), and the lesions were precisely located in the coronal, sagittal and transverse planes. The right iliac lesion (red line) and the right ischial lesion (green line) are delineated on CT (A-C) and SPECT (D-F) images, respectively. A: CT coronal plane; B: CT sagittal plane; C: CT transverse plane; D: SPECT coronal plane; E: SPECT sagittal plane; F: For SPECT cross-sectional images, the SUVmax, SUVmean, SUVmin of the right iliac lesions were 18.8, 11.7, 8.84, respectively, and the SUVmax, SUVmean, SUVmin of the right ischial lesions were 30.2, 15.8, 8.84, respectively
图 2 ROC曲线分析
Figure 2. ROC curve analysis. A: Diagnostic efficiency of SUVmax for bone; B: Diagnostic efficiency of SUVmean for bone; C: Diagnostic efficiency of SUVmin for bone.
表 1 SUV水平在骨转移组、良性病变组、对照组总体比较
Table 1. Comparison of SUV between the bone metastasis group, the benign lesion group and the control group
Group SUVmax SUVmean SUVmin Bone metastasis group [n=48, M(P25, P75)] 30.15(20.75, 45.43) 16.65(11.75, 23.1) 11.6(8.4, 15.27) Benig lesion group [n=39, M(P25, P75)] 13.5(10.4, 17.5) 8.22(5.89, 9.56) 5.83(2.63, 6.89) Control group (n=43, Mean±SD) 7.47±1.99 3.74±0.68 1.06±0.46 H 84.906 96.198 100.430 P ＜0.001 ＜0.001 ＜0.001 SUV: Standardized uptake value. 
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表 2 骨转移组、良性病变组中的SUV值ROC曲线分析
Table 2. ROC curve analysis of SUV value in bone metastasis group and benign lesion group
SUV value Cut off value AUC（95% CI） Sensibility (%) Specificity (%) SUVmax 26.6 0.876（0.803-0.948） 64.6 100.0 SUVmean 11.5 0.912（0.852-0.973） 77.1 92.3 SUVmin 8.1 0.901（0.838-0.965） 81.2 89.7
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表 3 初次诊断以及随访后最终诊断
Table 3. Initial diagnosis and final diagnosis after follow-up (n)
Diagnostic results Number of lesions First diagnosis Final follow-up results Bone metastases 40 48 Benign lesion 26 39 Unascertainable 21 Total 87 87 Conventional SPECT/CT fusion imaging diagnosis for the first time.
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表 4 常规SPECT/CT融合图像与定量SPECT/CT融合图像+SUVmean诊断比较
Table 4. Diagnostic comparison between conventional SPECT/CT fusion images and quantitative SPECT/CT fusion images +SUVmean (%)
Diagnostic method Clarify a diagnosis No definite diagnosis The overall diagnostic coincidence rate Bone metastases Benign lesion Conventional SPECT/CT fusion images 45.98（40/87） 29.88（26/87） 24.14（21/87） 75.86（66/87） Quantitative SPECT/CT fusion images +SUVmean 50.0247/87） 40.23（35/87） 5.75（5/87） 94.25（82/87） χ2 11.576 P 0.001
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