18F 氟代脱氧葡萄糖 PET/CT 与 99mTc-亚甲基二膦酸盐骨扫描在膀胱癌骨转移检测中的比较。

Comparison of 18F fluoride PET/CT and 99mTc-MDP bone scan in the detection of skeletal metastases in urinary bladder carcinoma.

机构信息

Department of Nuclear Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

出版信息

Clin Nucl Med. 2013 Aug;38(8):616-21. doi: 10.1097/RLU.0b013e31828da5cc.

DOI:10.1097/RLU.0b013e31828da5cc

PMID:23603596

Abstract

AIM

The aim of this study was to compare (18)F-fluoride PET/CT and (99m)Tc-MDP bone scintigraphy in the detection of skeletal metastases in urinary bladder carcinoma.

PATIENTS AND METHODS

In this prospective study, 48 patients with urinary bladder carcinoma (44 male and 4 female patients, aged 35-80 years) underwent (99m)Tc-MDP planar and SPECT/CT bone scan (BS) followed by (18)F-fluoride PET/CT within 48 hours. Skeletal metastasis diagnosed on each of these techniques was compared against a final diagnosis based on contrast-enhanced CT, MRI, skeletal survey, clinical follow-up, and histological correlation.

RESULTS

(18)F-fluoride PET/CT identified bony metastases and changed the management in 17 of 48 patients (35%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of (99m)Tc-MDP planar BS were 82.35%, 64.51%, 56%, 86.95%, and 70.83%; of (99m)Tc-MDP SPECT/CT were 88.23%, 74.19%, 65.21%, 92%, and 79.16%; and of (18)F-fluoride PET/CT were 100%, 87.09%, 80.95%, 100%, and 91.66%, respectively. Fair agreement between (99m)Tc-MDP planar BS and F-fluoride PET/CT (κ = 0.42) and excellent agreement between SPECT/CT and (18)F-fluoride PET/CT (κ = 0.74) were found.

CONCLUSIONS

( 18)F-fluoride PET/CT has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting bone metastases in urinary bladder carcinoma than conventional (99m)Tc-MDP planar BS. SPECT/CT improves all these parameters compared with planar BS and may serve as a cost-effective screening procedure for the detection of skeletal metastases in high-risk patients.

摘要

目的

本研究旨在比较（18）F-氟化物 PET/CT 和（99m）Tc-MDP 骨闪烁显像在膀胱癌骨转移中的检测作用。

患者和方法

在这项前瞻性研究中，48 例膀胱癌患者（44 例男性和 4 例女性，年龄 35-80 岁）接受了（99m）Tc-MDP 平面和 SPECT/CT 骨扫描（BS），随后在 48 小时内进行（18）F-氟化物 PET/CT。对每种技术诊断的骨转移与基于增强 CT、MRI、骨扫描、临床随访和组织学相关性的最终诊断进行了比较。

结果

（18）F-氟化物 PET/CT 在 48 例患者中的 17 例（35%）中发现了骨转移并改变了治疗方案。（99m）Tc-MDP 平面 BS 的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为 82.35%、64.51%、56%、86.95%和 70.83%；（99m）Tc-MDP SPECT/CT 分别为 88.23%、74.19%、65.21%、92%和 79.16%；（18）F-氟化物 PET/CT 分别为 100%、87.09%、80.95%、100%和 91.66%。（99m）Tc-MDP 平面 BS 与 F-氟化物 PET/CT 之间存在适度一致性（κ=0.42），SPECT/CT 与（18）F-氟化物 PET/CT 之间存在极好一致性（κ=0.74）。