Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, |Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Department of Orthopedics, |University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
Skeletal Radiol. 2020 Sep;49(9):1387-1395. doi: 10.1007/s00256-020-03426-8. Epub 2020 Apr 6.
To determine the value of prebiopsy F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in discriminating malignant from benign vertebral bone lesions.
This retrospective study included 53 patients with 55 vertebral bone lesions that underwent FDG-PET/CT before CT-guided biopsy. Pathologic examination of the biopsy sample and a minimum follow-up of 1 year were used as reference standard.
Sensitivity, specificity, positive predictive value, and negative predictive value of visual FDG-PET analysis (with lesion FDG uptake higher than liver FDG uptake as threshold for malignancy) in discriminating malignant from benign vertebral bone lesions were 91.3% (42/46), 22.2% (2/9), 85.7% (42/49), and 33.3% (2/6), respectively. The semiquantitative FDG-PET metrics SUV and SUV achieved areas under the receiver operating characteristics curve of 0.630 and 0.671, respectively. Malignant lesions demonstrated bone lysis more frequently than benign lesions (60.9% (28/46) vs. 22.2% (2/9)), and this difference was nearly significant (P = 0.064). All other clinical and conventional imaging characteristics (including patient age, gender, previous diagnosis of malignancy, bone pain, weight loss, any CT abnormality, sclerosis, cortical destruction, bone marrow replacement, associated extraosseous soft tissue mass, and accompanying vertebral height loss, multiple bone lesions on FDG-PET/CT, and suspicious extraosseous lesions on FDG-PET/CT) were not significantly different (P = 0.143 to 1.000).
FDG-PET/CT may steer the diagnosis (particularly thanks to a relatively high PPV and value of semiquantitative measurements), but cannot always classify vertebral bone lesions as malignant or benign with sufficient certainty. In these cases, biopsy and/or follow-up remain necessary to establish a final diagnosis.
确定 F-氟代-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）/计算机断层扫描（CT）在术前鉴别良恶性椎体病变中的价值。
本回顾性研究纳入了 53 例 55 个椎体病变患者，这些患者在 CT 引导下活检前均进行了 FDG-PET/CT 检查。以活检样本的病理检查和至少 1 年的随访为参考标准。
视觉 FDG-PET 分析（以病变 FDG 摄取高于肝脏 FDG 摄取作为恶性的阈值）在鉴别良恶性椎体病变中的敏感性、特异性、阳性预测值和阴性预测值分别为 91.3%（42/46）、22.2%（2/9）、85.7%（42/49）和 33.3%（2/6）。半定量 FDG-PET 指标 SUV 和 SUV 的受试者工作特征曲线下面积分别为 0.630 和 0.671。恶性病变比良性病变更常表现为骨溶解（60.9%（28/46）比 22.2%（2/9）），且差异接近显著（P=0.064）。所有其他临床和常规影像学特征（包括患者年龄、性别、恶性肿瘤既往诊断、骨痛、体重减轻、任何 CT 异常、硬化、皮质破坏、骨髓替代、伴发骨外软组织肿块、伴发椎体高度丢失、FDG-PET/CT 上的多发性骨病变和 FDG-PET/CT 上可疑的骨外病变）均无显著差异（P=0.143 至 1.000）。
FDG-PET/CT 可能有助于诊断（特别是由于较高的阳性预测值和半定量测量的价值），但不能总是确定椎体病变为恶性或良性，具有足够的确定性。在这些情况下，仍需要进行活检和/或随访以建立最终诊断。
