摘要
目的采用ROC曲线比较18F-FDGPET／CT、99TcmMDP骨显像及二者联合对骨转移患者的检出效能。方法296例恶性肿瘤患者在2个月内同时接受了18F-FDGPET／CT和99TcmMDP骨显像，对2种显像结果按5分法（0分：骨转移阴性，1分：可能阴性，2分：不能确定，3分：可能阳性，4分：肯定阳性）分别评分，两者之和为联合评分值。以病理诊断或临床随访为确诊“金标准”，采用。检验比较ROC曲线下面积，以评价骨显像、PET／CT及联合评分法对骨转移患者的检出效能，采用r检验比较不同方法在各自最佳诊断阈值下的灵敏度、特异性、准确性、阳性预测值、阴性预测值。结果296例患者中，确诊骨转移阳性61例（占20．6％）、阴性235例（占79．4％）。骨显像、PET／CT及联合评分诊断骨转移的ROC曲线下面积（95％可信区间）分别为0．919（0．867—0．971）、0．949（0．906～0．991）、0．994（0．988～0．999），联合评分法的曲线下面积明显大于骨显像（z=2．866，P=0．004）和PET／CT（z=2．027，P=0．043）各自单独评分法，骨显像和PET／CT法曲线下面积差异没有统计学意义（z=0．881，P=0．378）。最佳阈值点下，骨显像和PET／CT单独检出骨转移患者的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为90．2％（55／61）、85．1％（200／235）、86．1％（255／296）、61．1％（55／90）、97．1％（200／206）和88．5％（54／61）、97．0％（228／235）、95．3％（282／296）、88．5％（54／61）、97．0％（228／235），而联合评分检出的结果分别为98．4％（60／61）、95．7％（225／235）、96．3％（285／296）、85．7％（60／70）、99．6％（225／226）。PET／CT对骨转移患者检出的特异性（X2=19．600，P〈0．001）、准确性（X2=13．755，P〈0．001）、阳性预测值（x2=13．608，P〈0．001）均高于骨显像，灵敏度（r=0，P=1．000）差异无统计学意义；与骨显像、PET／CT单独评分比较，联合评分法检出的特异性（X2=19．862，P〈0．001）、准确性（x2=23．361，P〈0．001）和阳性预测值（x2=11．791，P=0．001）均明显高于骨显像，灵敏度明显高于PET／CT（x2=4．167，P=0．031）。结论18F—FDGPET／CT对骨转移患者的检出效能优于99Tcm—MDP骨显像，二者联合明显提高了对骨转移患者的检出率。
Objective To compare the efficacy of 18F-FDG PET/CT, 99Tcm-MDP bone scintigraphy （BS） , and combination of the two techniques （ PET/CT ＋ BS） for detecting bone metastasis by ROC curve analysis. Methods All 296 patients with various cancers, who underwent both 99Tcm-MDP BS and 18 F-FDG PET/CT within two months, were retrospectively analyzed. These images were interpreted according to 5-point scale （0 ： definitely negative, 1 ： probably negative, 2 ： equivocal, 3 ： probably positive, 4 ： definitely positive for bone metastasis） , and the scale of PET/CT ＋ BS was the sum of PET/CT and BS. In light of the confirmed diagnosis derived from pathology or follow-up, ROC curve analysis was performed. The area under the ROC curve （AUC） was compared by z-test. Results Of 296 cases, 61 （20.6%） were confirmed as bone metastases and 235 （79.4%） were negative. The AUC were 0. 919 （95% confidence interval （95% CI） ： 0. 867 - 0. 971 ） for BS, 0. 949 （95% CI： 0. 906- 0. 991 ） for PET/CT, and 0. 994（95%CI： 0. 988-0. 999） for PET/CT ＋ BS, retrospectively. The AUC of PET/CT ＋ BS was statistically significantly larger than that of BS （z = 2. 866, P = 0.004） or PET/CT （z = 2. 027, P = 0.043 ）, while the AUC of PET/CT was larger than that of BS, but no statistically significance （z =0. 881, P =0. 378） was showed. The optimal sensitivity, specificity, accuracy, positive predictive value （PPV）, negative predictive value（NPV） were 90.2% （55/61）, 85. 1% （200/235）, 86. 1% （255/296）, 61. 1% （55/90）, 97. 1% （200/206） for BS, 88.5% （54/61）, 97.0% （228/235）, 95.3% （282/296）, 88.5% （54/61）, 97.0% for PET/CT, and 98.4% （60/61）, 95.7% （225/235）, 96.3% （285/296）, 85.7% （60/70） for PET/CT ＋ BS, respectively. The specificity 0（2 = 19.862, P 〈 0.001 ）, accuracy 0（2 = 23. 361, P 〈 0. 001 ） and PPV 0（2 = 11. 791, P =0.001 ） of PET/CT ＋ BS were significantly higher than those of BS, the sensitivity of PET/CT ＋ BS was significantly higher than that of PET/CT 0（2 =4. 167, P=0.031）. Compared with BS, PET/CT had a higher specificity 0（2 = 19.600, P 〈0. 001 ）, accuracy 0（2 = 13.755, P 〈 0. 001 ）, PPV 0（2 = 13.608, P 〈 0. 001）, but their sensitivity showed no statistically significant difference 0（2 = 0, P = 1. 000）. Condusions The efficacy of ISF-FDG PET/CT for detecting malignant bone metastasis was superior to that of 99Tcm-MDP BS alone. The detection ability can be obviously improved by combination of the two techniques.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2011年第1期25-28,共4页
Chinese Journal of Nuclear Medicine
