Kitajima Kazuhiro, Tsuchitani Tatsuya, Takahashi Yoshiyuki, Minami Toshiyuki, Yokoi Takashi, Nakamura Akifumi, Hashimoto Masaki, Kuribayashi Kozo, Kijima Takashi, Hasegawa Seiki, Yamakado Koichiro
Department of Radiology, Hyogo College of Medicine, Hyogo, Japan.
Department of Radiological Technology, Hyogo College of Medicine College Hospital, Hyogo, Japan.
Case Rep Oncol. 2021 Mar 10;14(1):391-396. doi: 10.1159/000513907. eCollection 2021 Jan-Apr.
We report a case of bone metastasis arising from lung cancer, including quantitative values obtained with bone single-photon emission computed tomography/computed tomography (SPECT/CT), which were useful to evaluate the treatment response. The first bone SPECT/CT during pembrolizumab therapy for lung cancer recurrence showed intense Tc-HMDP uptake of the right femur head and mild uptake of the left ribs. After the palliative radiotherapy for the right femur head metastasis and chemotherapy, the second bone SPECT/CT showed a decrease in focal uptake of the right femur hip and increasing uptake of the left ribs. There was also new uptake appearance in the sternum, right rib, spine (Th2, Th9, Th12, L4, S1), and bilateral pelvic bone (left ilium, acetabular cartridge, femur, right ilium and ischium). The change of maximum standardized uptake values (SUVmax) for the right femur head and left third and eighth rib bony metastases were -72.6% (from 22.96 to 6.28), +407.7% (from 2.97 to 15.08), and +229.2% (from 2.60 to 8.56), respectively. The change of whole-lesion metabolic bone volume and total bone uptake was +235.4% (from 22.75 to 76.3 cm) and +219.1% (from 205.0 to 654.09), respectively. Two quantitative bone SPECT/CT images clearly showed the good response of femur head metastasis due to radiotherapy, and progression of other bone metastases regardless of chemotherapy.
我们报告了一例源自肺癌的骨转移病例，包括通过骨单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）获得的定量值，这些值有助于评估治疗反应。在针对肺癌复发的帕博利珠单抗治疗期间进行的首次骨SPECT/CT显示，右股骨头有强烈的锝-亚甲基二膦酸盐（Tc-HMDP）摄取，左肋骨有轻度摄取。在对右股骨头转移灶进行姑息性放疗和化疗后，第二次骨SPECT/CT显示右股骨髋部的局灶性摄取减少，左肋骨摄取增加。胸骨、右肋骨、脊柱（胸2、胸9、胸12、腰4、骶1）以及双侧骨盆骨（左髂骨、髋臼软骨、股骨、右髂骨和坐骨）也出现了新的摄取表现。右股骨头、左第三和第八肋骨骨转移灶的最大标准化摄取值（SUVmax）变化分别为-72.6%（从22.96降至6.28）、+407.7%（从2.97增至15.08）和+229.2%（从2.60增至8.56）。全病灶代谢骨体积和总骨摄取的变化分别为+235.4%（从22.75增至76.3 cm）和+219.1%（从205.0增至654.09）。两张定量骨SPECT/CT图像清楚地显示了放疗对股骨头转移灶的良好反应，以及其他骨转移灶无论化疗与否的进展情况。
