Strobel Klaus, Burger Cyrill, Seifert Burkhardt, Husarik Daniela B, Soyka Jan D, Hany Thomas F
Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland, 8091.
AJR Am J Roentgenol. 2007 May;188(5):W467-74. doi: 10.2214/AJR.06.1215.
The purpose of this study was to evaluate the diagnostic performance of planar 99mTc methylene diphosphonate bone scintigraphy compared with SPECT and SPECT fused with CT in patients with focal bone lesions of the axial skeleton.
Thirty-seven patients with 42 focal lesions of the axial skeleton were included in this prospective study. All patients underwent planar scintigraphy, SPECT through the focal lesions, and SPECT-guided CT. SPECT and CT images then were fused digitally. The three types of images were evaluated separately from one another by two experienced reviewers working to consensus. Visibility of the lesions, diagnostic performance, and certainty in diagnosis were evaluated. Performance for specific diagnoses also was evaluated. Histologic, MRI, and clinical follow-up findings were used as the reference standard.
Visibility of the lesions was significantly better with SPECT than with planar scintigraphy (p < 0.0001). Sensitivity and specificity for differentiation of benign and malignant bone lesions were 82% and 94% for planar scintigraphy, 91% and 94% for SPECT, and 100% and 100% for SPECT fused with CT. Differences between the three methods of differentiating benign and malignant lesions did not reach statistical significance. Certainty in diagnosis was significantly higher for SPECT fused with CT than for planar scintigraphy (p = 0.004) and SPECT (p = 0.004). A specific diagnosis was made with planar scintigraphy in 64% of cases, with SPECT in 86%, and with SPECT fused with CT in all cases.
Planar scintigraphy may suffice for differentiating benign and malignant lesions of the axial skeleton, but SPECT fused with CT significantly increases certainty in diagnosis and is the best tool for making a specific diagnosis.
本研究旨在评估平面99mTc亚甲基二膦酸盐骨闪烁显像与单光子发射计算机断层扫描（SPECT）以及SPECT与计算机断层扫描（CT）融合成像在诊断中轴骨局灶性病变患者时的诊断性能。
本前瞻性研究纳入了37例患有42处中轴骨局灶性病变的患者。所有患者均接受了平面闪烁显像、通过局灶性病变部位的SPECT检查以及SPECT引导下的CT检查。然后将SPECT和CT图像进行数字融合。由两名经验丰富的阅片者各自独立对这三种类型的图像进行评估，直至达成共识。评估病变的可视性、诊断性能以及诊断的确定性。还评估了特定诊断的性能。组织学、磁共振成像（MRI）以及临床随访结果用作参考标准。
SPECT对病变的可视性明显优于平面闪烁显像（p < 0.0001）。平面闪烁显像鉴别良性和恶性骨病变的灵敏度和特异度分别为82%和94%，SPECT为91%和94%，SPECT与CT融合成像为100%和100%。三种鉴别良性和恶性病变方法之间的差异未达到统计学意义。SPECT与CT融合成像诊断的确定性明显高于平面闪烁显像（p = 0.004）和SPECT（p = 0.004）。平面闪烁显像在64%的病例中做出了特定诊断，SPECT在86%的病例中做出了特定诊断，SPECT与CT融合成像在所有病例中均做出了特定诊断。
平面闪烁显像可能足以鉴别中轴骨的良性和恶性病变，但SPECT与CT融合成像显著提高了诊断的确定性，是做出特定诊断的最佳工具。
