Application of 18F-FDG PET/CT in diagnosis of bone metastases of unknown primary tumor
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摘要:
目的 探讨18氟-脱氧葡萄糖PET/CT在原发灶不明的骨转移瘤（BMUPT）患者中的应用价值，并总结BMUPT患者PET/CT图像特征。 方法 回顾性分析本院PET/CT中心检查的49例原发灶不明的骨转移瘤患者的影像资料，记录其原发灶部位、淋巴结转移、远处脏器转移、骨转移部位及骨转移性质，同时测定各骨转移灶最大标准化摄取值（SUVmax），对不同骨转移性质及部位的SUVmax做统计学分析。 结果 PET/CT检查共正确检出48例原发灶, 有1例未正确检出，新发现42例合并淋巴结转移，26例合并器官转移。49例患者中成骨性转移9例，溶骨性转移33例，混合性转移7例。各部位骨转移发生率依次为：脊柱91.8%、骨盆85.7%、胸部77.5%、四肢57.1%、颅骨24.4%。溶骨性转移SUVmax大于成骨性转移（t=3.55，P<0.05）。成骨性转移、溶骨性转移各部位之间SUVmax差异均无统计学意义（P>0.05）。 结论 PET/CT在BMUPT的原发灶寻找中具有很高的准确性，且能发现新的淋巴结及远处转移灶，可以BMUPT患者病情评估及综合治疗提供更全面的价值。 -
关键词:
- 18氟-脱氧葡萄糖 /
- 正电子发射型计算机断层显像/计算机体层成像 /
- 骨转移瘤 /
- 不明原发灶
Abstract:Objective To investigate the clinical value of 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography/computed tomography(PET/CT) in diagnosis of bone metastases of unknown primary tumor(BMUPT), and summarize the features of PET/CT findings in patients with BMUPT. Methods The imaging data of 49 patients with BMUPT in our hospital were retrospectively analyzed. Primary tumor sites, lymph nodes metastases, organ metastases and bone metastases were recorded. The maximum standardized uptake value(SUVmax) of each bone metastasis were determined and the SUVmax of different bone metastases properties and metastases sites were statistically analyzed. Results Forty-eight cases of primary tumor were correctly detected by PET/CT, 1 case was not correctly detected. 42 cases were newly found with lymph nodes metastases and 26 cases were found with organ metastasis. Among the 49 patients, there were 9 cases of osteogenic metastases, 33 cases of osteolytic metastases and 7 cases of mixed metastases.Incidence of bone metastasis in each place was spine>pelvis>chest>limbs>skull. The SUVmax of osteolytic metastases was higher than that of osteogenic metastases(t=3.55, P<0.05). Differences of SUVmax between osteogenic and osteolytic metastasis at the sites of bone metastases was not significant(P>0.05). Conclusion PET/CT has a high accuracy in diagnosis for a primary tumor of BMUPT.It can find new lymph nodes and organ metastases, which provides more comprehensive value for the evaluation and treatment of BMUPT patients. -
图 1 混合性骨转移
患者男, 70岁, 左侧腰部痛3月余, 外院MRI示骨盆多发异常信号而就诊; A: 右侧髂骨溶骨性破坏, 左侧骶骨结节状骨密度增高影; B: PET示右侧骶骨及周围软组织代谢增高, 左侧骶骨结节状代谢增高, 胃贲门部高代谢肿块（红色长箭头所指）, 肝脏多发低密度占位伴FDG代谢增高（白色长箭头所指）, 考虑胃癌伴肝转移，全身多发骨转移, 病理结果为胃癌.
图 2 成骨性骨转移
患者男, 39岁, 因摔伤后外院行MRI检查示腰骶椎多发占位入院, PET/CT示左侧肱骨头结节状骨密度增高伴FDG代谢增高灶（A, 红色箭头所指）, 右上肺高代谢肿块影（B, 蓝色箭头所指）, 考虑为肺癌伴全身多发骨转移, 病理结果为肺癌.
图 3 溶骨性骨转移
患者女, 52岁, 因颈椎疼痛, CT发现第三颈椎骨质破坏而就诊, PET/CT示第7胸椎骨质破坏（A, 红色箭头）伴FDG代谢增高（B, 红色箭头）, 左侧乳腺高代谢结节（B, 白色箭头）, 考虑为乳腺癌伴全身多发骨转移, 病理结果为乳腺癌.
表 1 骨转移原发病灶及转移类型
转移方式 总例数n（%） 原发灶（n） 成骨性转移 9（18.4） 前列腺癌（6） 肺癌（1） 胃癌（1） 乳腺癌（1） 溶骨性转移 33（67.3） 肺癌（16） 胃癌（5） 肝癌（3） 肾癌（2） 鼻咽癌（1） 宫颈癌（1） 甲状腺癌（1） 前列腺癌（1） 乳腺癌（1） 胰腺癌（1） 臀尾部平滑肌肉瘤（1） 假阳性（1） 混合性转移 7（14.3） 肺癌（4） 胃癌（2） 前列腺癌（1） 
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表 2 各部位骨转移瘤SUVmax比较
转移方式 脊柱（n=45） 骨盆（n=42） 胸部（n=38） 四肢（n=28） 颅骨（n=12） F P 溶骨性转移 10.54±3.36 9.91±3.98 8.55±3.86 8.74±3.41 9.80±2.68 1.563 0.189 成骨性转移 7.50±4.10 6.54±2.67 6.11±3.43 6.68±3.69 6.57±2.82 0.387 0.817
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