全身 SPECT/CT 探测 Tc 标记二膦酸盐骨转移的诊断性能：系统评价和荟萃分析。

Diagnostic performance of whole-body SPECT/CT in bone metastasis detection using Tc-labelled diphosphate: a systematic review and meta-analysis.

机构信息

Discipline of Medical Imaging Science and Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, 2006, Australia; Department of Radiology and Medical Imaging, Faculty of Applied Medical Sciences, Najran University, Saudi Arabia.

Discipline of Medical Imaging Science and Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, New South Wales, 2006, Australia; Department of Medical Physics, Westmead Hospital, Sydney, New South Wales, Australia.

出版信息

Clin Radiol. 2020 Dec;75(12):961.e11-961.e24. doi: 10.1016/j.crad.2020.07.026. Epub 2020 Aug 28.

DOI:10.1016/j.crad.2020.07.026

PMID:32868091

Abstract

AIM

To evaluate the diagnostic performance of whole-body (WB) integrated single photon emission tomography (SPECT)/computed tomography (CT) in detecting bone metastasis (BM) and to investigate whether WB-SPECT/CT offered any additional benefit value compared to planar bone scintigraphy (PBS) with Tc-hydroxy-methylene diphosphonate or Tc methylene diphosphonate.

MATERIALS AND METHODS

Medline, EMBASE, SCOPUS, Web of Science, and CINAHL were searched systematically up to 28 August 2019. All studies using histopathological analysis and/or follow-up imaging and clinical data as the reference standard were eligible for inclusion.

RESULTS

Eleven studies (1,611 patients) were analysed. Based on patient analysis, the sensitivity, specificity, and area under the curve (AUC) of WB-SPECT/CT were 92% (92% confidence interval [CI], 89-95%), 95% (95% CI, 94-96%), and 0.9835, respectively, in the case of negative equivocal findings for BM, and 94% (95% CI, 91-96%), 94% (95% CI, 92-95%), and 0.9790, respectively, when regarded positive. On a lesion basis, these parameters were 91% (95% CI, 89-94%), 96% (95% CI, 94-97%), and 0.9906, respectively, in the case negative equivocal findings, and 92% (95% CI, 89-94%), 95% (95% CI, 94-97%), and 0.9898, respectively, when regarded positive. Comparing 1,265 patients from eight studies, higher sensitivity (92% versus 74%, p=0.04) and specificity for WB-SPECT/CT against PBS (93% versus 80%, p=0.01) in the case of positive equivocal findings; however, when regarded negative, WB-SPECT/CT demonstrated higher sensitivity (91% versus 70%, p=0.01), but no significant difference was apparent in specificity (94% versus 89%, p=0.07).

CONCLUSION

Compared to PBS, WB-SPECT/CT had superior diagnostic accuracy in BM detection and exhibited a more reliable performance with less equivocal results.

摘要

目的

评估全身（WB）单光子发射断层扫描（SPECT）/计算机断层扫描（CT）在检测骨转移（BM）中的诊断性能，并探讨与 Tc-羟基亚甲基二膦酸盐或 Tc 亚甲基二膦酸盐的平面骨闪烁扫描（PBS）相比，WB-SPECT/CT 是否具有额外的附加价值。

材料和方法

系统检索了 Medline、EMBASE、SCOPUS、Web of Science 和 CINAHL，截至 2019 年 8 月 28 日。所有使用组织病理学分析和/或随访影像学和临床数据作为参考标准的研究都符合纳入标准。

结果

分析了 11 项研究（1611 名患者）。基于患者分析，对于 BM 的阴性不确定结果，WB-SPECT/CT 的敏感性、特异性和曲线下面积（AUC）分别为 92%（92%置信区间，89-95%）、95%（95%置信区间，94-96%）和 0.9835；当视为阳性时，分别为 94%（95%置信区间，91-96%）、94%（95%置信区间，92-95%）和 0.9790。基于病变分析，对于阴性不确定结果，这些参数分别为 91%（95%置信区间，89-94%）、96%（95%置信区间，94-97%）和 0.9906；当视为阳性时，分别为 92%（95%置信区间，89-94%）、95%（95%置信区间，94-97%）和 0.9898。比较了来自八项研究的 1265 名患者，对于阳性不确定结果，WB-SPECT/CT 的敏感性（92%比 74%，p=0.04）和特异性（93%比 80%，p=0.01）均高于 PBS；然而，当视为阴性时，WB-SPECT/CT 表现出更高的敏感性（91%比 70%，p=0.01），但特异性无明显差异（94%比 89%，p=0.07）。