Even-Sapir Einat, Metser Ur, Flusser Gideon, Zuriel Limor, Kollender Yehuda, Lerman Hedva, Lievshitz Gennady, Ron Ilan, Mishani Eyal
Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Nucl Med. 2004 Feb;45(2):272-8.
18F-fluoride PET/CT was performed on 44 oncologic patients to evaluate its diagnostic accuracy in assessing malignant osseous involvement and in differentiating malignant from benign bone lesions.
(18)F-fluoride PET and (18)F-fluoride PET/CT were interpreted separately. Lesions showing increased (18)F-fluoride uptake were categorized as malignant, benign, or inconclusive. The final diagnosis of lesions was based on histopathology, correlation with contemporaneous diagnostic CT or MRI, or clinical follow-up of at least 6 mo (mean, 10 +/- 3 mo).
Increased (18)F-fluoride uptake was detected at 212 sites, including 111 malignant lesions, 89 benign lesions, and 12 lesions for which the final diagnosis could not be determined. In a lesion-based analysis, the sensitivity of PET alone in differentiating benign from malignant bone lesions was 72% when inconclusive lesions were considered false negative and 90% when inconclusive lesions were considered true positive. On PET/CT, 94 of 111 (85%) metastases presented as sites of increased uptake with corresponding lytic or sclerotic changes, and 16 of the 17 remaining metastases showed normal-appearing bone on CT, for an overall sensitivity of 99% for tumor detection. For only 1 metastasis was PET/CT misleading, suggesting the false diagnosis of a benign lesion. The specificity of PET/CT was significantly higher than that of PET alone (97% vs. 72%, P < 0.001). PET/CT identified benign abnormalities at the location exactly corresponding to the scintigraphic increased uptake for 85 of 89 (96%) benign lesions. In a patient-based analysis, the sensitivity of PET and PET/CT was 88% and 100%, respectively (P < 0.05) and the specificity was 56% and 88%, respectively (not statistically significant). Among the 12 patients referred for (18)F-fluoride assessment because of bone pain despite negative findings on (99m)Tc-methylene diphosphonate bone scintigraphy, (18)F-fluoride PET/CT suggested malignant bone involvement in all 4 patients with proven skeletal metastases, a potential benign cause in 4 of 7 patients who had no evidence of metastatic disease, and a soft-tissue tumor mass invading a sacral foramen in 1 patient.
The results indicate that (18)F-fluoride PET/CT is both sensitive and specific for the detection of lytic and sclerotic malignant lesions. It accurately differentiated malignant from benign bone lesions and possibly assisted in identifying a potential cause for bone pain in oncologic patients. For most lesions, the anatomic data provided by the low-dose CT of the PET/CT study obviates the performance of full-dose diagnostic CT for correlation purposes.
对44例肿瘤患者进行了18F - 氟化物PET/CT检查，以评估其在评估恶性骨受累及区分恶性与良性骨病变方面的诊断准确性。
分别解读18F - 氟化物PET和18F - 氟化物PET/CT。18F - 氟化物摄取增加的病变分为恶性、良性或不确定。病变的最终诊断基于组织病理学、与同期诊断性CT或MRI的相关性或至少6个月（平均10±3个月）的临床随访。
在212个部位检测到18F - 氟化物摄取增加，包括111个恶性病变、89个良性病变和12个最终诊断无法确定的病变。在基于病变的分析中，当不确定病变被视为假阴性时，PET单独区分良性与恶性骨病变的敏感性为72%，当不确定病变被视为真阳性时为90%。在PET/CT上，111个转移灶中的94个（85%）表现为摄取增加部位并伴有相应的溶骨性或硬化性改变，其余17个转移灶中的16个在CT上显示骨外观正常，肿瘤检测的总体敏感性为99%。仅1个转移灶被PET/CT误导，提示为良性病变的误诊。PET/CT的特异性显著高于单独PET（97%对72%，P < 0.001）。PET/CT在89个良性病变中的85个（96%）与闪烁显像摄取增加部位完全对应的位置识别出良性异常。在基于患者的分析中，PET和PET/CT的敏感性分别为88%和100%（P < 0.05），特异性分别为56%和88%（无统计学意义）。在12例因骨痛而进行18F - 氟化物评估的患者中，尽管99mTc - 亚甲基二膦酸盐骨显像结果为阴性，但18F - 氟化物PET/CT提示所有4例经证实有骨转移癌的患者存在恶性骨受累，7例无转移疾病证据的患者中有4例可能为良性原因，1例患者为软组织肿瘤侵犯骶孔。
结果表明，18F - 氟化物PET/CT对溶骨性和硬化性恶性病变的检测既敏感又特异。它能准确区分恶性与良性骨病变，并可能有助于确定肿瘤患者骨痛的潜在原因。对于大多数病变，PET/CT研究中的低剂量CT提供的解剖数据避免了为相关性目的而进行全剂量诊断性CT检查。
