Katayama Takashi, Kubota Kazunori, Machida Youichi, Toriihara Akira, Shibuya Hitoshi
Department of Radiology, Faculty of Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan,
Ann Nucl Med. 2012 Jun;26(5):426-35. doi: 10.1007/s12149-012-0595-2. Epub 2012 Apr 3.
The purpose of this study was to clarify the significance of positron emission tomography (PET) and computed tomography (CT) findings for evaluating the bone metastasis of breast cancer during therapy.
Forty-seven patients with bone metastases from breast cancer who underwent sequential FDG-PET/CT studies during therapy were enrolled. A total of 771 lesions were identified. The changes in the PET and CT findings were compared with the tumor marker levels in each patient by calculating the weighted kappa value. The correlation between the PET and CT findings was examined for each lesion by an adjusted Chi-square test.
The change in the tumor marker levels was substantially correlated with the PET findings and moderately correlated with the CT findings (weighted kappa = 0.780 and 0.585 for quadratic weighting, respectively). An increase in FDG uptake was correlated with lytic changes on the CT images (62/65, 95.4 %, p < 0.05). Sclerotic changes suggested improvement, but sclerosis and progression occurred at the same time in some lesions.
Changes of FDG uptake are useful for evaluating individual bone metastases in cases of breast cancer during therapy. Lytic change on CT images suggests progression of bone metastasis. The lysis-progression/sclerosis-improvement pattern was observed in the majority of subjects, but a sclerosis-progression pattern was also observed. The hybrid pattern of increase of FDG uptake on PET/lytic change on CT is most accurate to show progression of bone metastases. Assessments of these processes during therapy are necessary for the precise evaluation of bone metastases.
本研究旨在阐明正电子发射断层扫描（PET）和计算机断层扫描（CT）结果在评估乳腺癌治疗期间骨转移方面的意义。
纳入47例乳腺癌骨转移患者，这些患者在治疗期间接受了序贯FDG-PET/CT检查。共识别出771个病灶。通过计算加权kappa值，将PET和CT结果的变化与每位患者的肿瘤标志物水平进行比较。通过校正卡方检验检查每个病灶的PET和CT结果之间的相关性。
肿瘤标志物水平的变化与PET结果显著相关，与CT结果中度相关（二次加权时加权kappa分别为0.780和0.585）。FDG摄取增加与CT图像上的溶骨性改变相关（62/65，95.4%，p<0.05）。硬化性改变提示病情改善，但在一些病灶中硬化和进展同时出现。
FDG摄取的变化有助于评估乳腺癌治疗期间个体骨转移情况。CT图像上的溶骨性改变提示骨转移进展。大多数患者观察到溶骨进展/硬化改善模式，但也观察到硬化进展模式。PET上FDG摄取增加/CT上溶骨性改变的混合模式最能准确显示骨转移进展。治疗期间对这些过程进行评估对于精确评估骨转移是必要的。
