摘要
目的探讨联合18F-氟脱氧葡萄糖(FDG)和18F-氟化钠(NaF)正电子发射体层成像(PET)对骶骨衰竭性骨折(SIF)及转移瘤鉴别诊断的价值。方法回顾性分析在3 d内先后行18F-NaF PET/CT和18F-FDG PET/CT检查,2项检查中至少有1项中发现骶骨局部显像剂异常摄取的122例病人。将病人分为SIF组(52例)和骶骨转移瘤组(70例)。采用卡方检验比较18F-FDG和18F-NaF对病灶的检出率;采用Mann-Whitney U检验比较2组间18FNaF、18F-FDG的最大标准摄取值(SUVmax-NaF和SUVmax-FDG)及两者的比值(SUVmax-NaF/FDG)。采用受试者操作特征(ROC)曲线判断3种指标对SIF和骶骨转移瘤的鉴别诊断效能。结果在横断面PET/CT上,SIF表现为18F-FDG沿骨折线呈条片状、结节状浓聚;18F-NaF为沿骨折线走行的片状、结节状的高摄取,或形成典型"H"形代谢活跃区(由骶骨体水平浓聚区和双侧骶骨翼纵行浓聚区连接组成)。骶骨转移瘤表现为18F-FDG呈不规则片状、结节状浓聚,18F-NaF呈片状、结节状或围绕软组织肿块不规则条形、新月形、环形浓聚,软组织肿块通常表现为显像剂分布缺损。18F-NaF对SIF的检出率(100%)高于18F-FDG(92.3%)(P<0.05),但对骶骨转移瘤的检出率两者相等(100%)。SIF组的SUVmax-NaF、SUVmax-NaF/FDG高于骶骨转移瘤组,而SUVmax-FDG低于骶骨转移瘤组(均P<0.05)。SUVmax-NaF/FDG鉴别骶骨转移瘤和SIF的ROC曲线下面积(AUC)、敏感度、特异度均最高。结论18F-FDG联合18F-NaF PET/CT对鉴别诊断SIF和转移瘤有增益价值。
Objective To investigate the value of 18F-fluorodeoxyglucose(FDG) combined with 18F-sodium fluoride(NaF) PET/CT imaging in differentiating sacral insufficiency fractures(SIFs) from metastases. Methods A total of 122 patients who underwent 18F-NaF PET/CT and 18F-FDG PET/CT examinations within 3 days interval and presented abnormal radioactivity at the sacrum at least in one imaging session were enrolled. Patients were divided into 2 groups:SIFs group(n=52) and sacral metastatic tumor group(n =70). The Chi-square test or Mann-Whitney U test was used to compare the detection rates on 18F-FDG and 18F-NaF PET/CT, the maximum standardized uptake value of 18F-NaF and 18F-FDG(SUVmaxNaF and SUVmax-FDG) and their ratio(SUVmax-NaF/FDG) between the two groups when appropriate. The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic efficacy of these three indicators for differentiating SIFs from metastases. Results On the transverse section, the SIFs showed striped or nodular radioactive accumulation of 18F-FDG/ 18FNaF along the fracture line, or a typical "H" shaped 18F-NaF accumulation area which was constructed by the horizontally concentrated sacral body and bilateral longitudinally concentrated sacral wings. Sacral metastases show irregular flakes and nodular radioactive concentration of 18F-FDG on the cross-section, or showed bar-, crescent-, and ring-like 18F-NaF accumulation around the soft tissue mass and tracer distribution defect in the soft tissue mass area. The detection rate of SIF on 18F-NaF PET/CT(100%) was higher than that on 18F-FDG PET/CT(92.3%)(P <0.05). The detection rate of sacral metastases with both methods was equal(100%). The SUVmax-NaF and SUVmax-NaF/FDG of the SIF group were significantly higher than those of the sacral metastasis group, and the SUVmax-FDG was significantly lower than that of the sacral metastasis group(both P<0.05). The area under ROC curve(AUC), sensitivity and specificity of SUVmax-NaF/FDG for the differential diagnosis were the highest. Conclusion 18F-FDG combined with 18F-NaF PET/CT has incremental value in differentiating SIFs from metastases.
作者
夏雨霄
丁浩源
赵艳红
刘会攀
王姊
陈跃
XIA Yuxiao;DING Haoyuan;ZHAO Yanhong;LIU Huipan;WANG Zi;CHEN Yue(Department of Nuclear Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;The Second Affiliated Hospital of Chengdu Medical College(Nuclear Industry 416 Hospital))
出处
《国际医学放射学杂志》
北大核心
2020年第4期414-419,共6页
International Journal of Medical Radiology
基金
泸州市人民政府-西南医科大学核素精准诊疗研究项目(2016LZXNYD-G01)
四川省重点实验室建设基金(2018JPT0023)。
关键词
骶骨
衰竭性骨折
转移瘤
正电子发射体层成像
氟代脱氧葡萄糖
氟化钠
最大标准摄取值
Sacrum
Insufficiency fractures
Metastasis
Positron emission tomography
Fluorodeoxyglucose
Sodium fluoride
Maximum standardized uptake value
