Zhong Xi, Li Jiansheng, Zhang Linqi, Lu Binggui, Yin Jinxue, Chen Zhijun, Zhang Jian, Tang Rijie
Department of Radiology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China.
Department of Nuclear Medicine, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China.
Front Oncol. 2019 Mar 28;9:183. doi: 10.3389/fonc.2019.00183. eCollection 2019.
Insufficiency fracture (IF) can show increased uptake on a bone scan (BS). IFs are often misinterpreted as bone metastases if the characteristic "Honda sign" (H-sign) is invisible. The purpose of the present study was to evaluate the utility of magnetic resonance imaging (MRI) alone for the characterization of IF and bone metastasis after radiotherapy in patients with cervical cancer detected by BS. Our study included 40 patients with cervical cancer after radiotherapy that showed pelvic emerging increased uptake on a BS during follow-up. Then further MRI examination was performed in all patients. Two radiologists independently reviewed the MR images, and the sensitivity, specificity and accuracy were calculated based on the mean scores. Diagnostic validity of the inter-observer was calculated by using kappa statistics. The gold standard was based on radiologic findings, clinical data and follow-up at least 12 months. A total of 57 emerging bone lesions detected at BS were identified in the reference standard, including 43 IFs and 14 bone metastases. Only 20 patients showed a "H-sign" on the BS images. Using MRI analysis, all lesions detected by BS were found in MRI by both radiologists. On average, the sensitivity, specificity, and accuracy for distinguishing IFs from bone metastases were 95.3% (41/43), 92.8% (13/14), and 94.7% (54/57), respectively. The inter-observer variability was determined to be very good (kappa value = 0.962). MRI is a reliable diagnostic technique for the further characterization of emerging lesions detected by BS, MRI shows great diagnostic efficiency in the differentiation of IF and bone metastasis.
insufficiency骨折（IF）在骨扫描（BS）上可显示摄取增加。如果特征性的“本田征”（H征）不可见，IF常被误诊为骨转移。本研究的目的是评估单独使用磁共振成像（MRI）对宫颈癌患者放疗后IF和骨转移的特征进行鉴别诊断的效用。我们的研究纳入了40例放疗后的宫颈癌患者，这些患者在随访期间BS显示盆腔出现摄取增加。然后对所有患者进行了进一步的MRI检查。两位放射科医生独立阅片，并根据平均评分计算敏感性、特异性和准确性。通过kappa统计量计算观察者间诊断的有效性。金标准基于影像学表现、临床资料和至少12个月的随访。在参考标准中，共识别出57个在BS上发现的新发骨病变，其中包括43个IF和14个骨转移。只有20例患者在BS图像上显示出“H征”。通过MRI分析，两位放射科医生均在MRI上发现了所有在BS上检测到的病变。平均而言，区分IF和骨转移的敏感性、特异性和准确性分别为95.3%（41/43）、92.8%（13/14）和94.7%（54/57）。观察者间变异性被确定为非常好（kappa值 = 0.962）。MRI是一种可靠的诊断技术，可进一步鉴别BS检测到的新发病变，在区分IF和骨转移方面显示出很高的诊断效率。
