Han L J, Au-Yong T K, Tong W C, Chu K S, Szeto L T, Wong C P
Department of Nuclear Medicine, KLG, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Eur J Nucl Med. 1998 Jun;25(6):635-8. doi: 10.1007/s002590050266.
Bone scan has long been considered to be an important diagnostic test in searching for bone metastases. However, considerable difficulty is encountered in the vertebral region due to the complexity of structures and the fact that other benign lesions, especially degenerative changes, are very common there. Single-photon emission tomography (SPET) has been reported to be useful in the differentiation of benign from malignant conditions. Here we report our experience with bone SPET in the diagnosis of vertebral metastases. This is a retrospective study of technetium-99m methylene diphosphonate (MDP) bone scans in 174 consecutive patients who were referred for the investigation of back pain in our department. MDP planar and SPET images were obtained. Of teh 174 patients, 98 had a known history of malignant tumours. The diagnosis of vertebral metastasis was made on the basis of the patients' clinical histories and the findings with other imaging techniques such as magnetic resonance imaging, computed tomography or follow-up bone scan. We found that the presence of pedicle involvement as seen on SPET was an accurate diagnostic criterion of vertebral metastasis. SPET had a sensitivity of 87%, a specificity of 91%, a positive predictive value of 82%, a negative predictive value of 94% and an accuracy of 90%. On the other hand, planar study had a sensitivity of 74%, a specificity of 81%, a positive predictive value of 64%, a negative predictive value of 88% and an accuracy of 79% in diagnosing vertebral metastasis. Except with regard to the negative predictive value, SPET performed statistically better than planar imaging. Only 9/147 (6.4%) lesions involving the vertebral body alone and 3/49 (6.1%) lesions involving facet joints alone were subsequently found to be metastases. We conclude that bone SPET is an accurate diagnostic test for the detection of vertebral metastases and is superior to planar imaging in this respect.
长期以来，骨扫描一直被认为是寻找骨转移瘤的一项重要诊断检查。然而，由于椎骨区域结构复杂，且其他良性病变，尤其是退行性改变在该区域非常常见，因此在该区域进行诊断存在相当大的困难。据报道，单光子发射断层扫描（SPET）有助于鉴别良性与恶性病变。在此，我们报告我们应用骨SPET诊断椎骨转移瘤的经验。这是一项对174例因背痛前来我院就诊并接受连续锝-99m亚甲基二膦酸盐（MDP）骨扫描患者的回顾性研究。获取了MDP平面图像和SPET图像。在这174例患者中，98例有恶性肿瘤病史。椎骨转移瘤的诊断基于患者的临床病史以及其他成像技术（如磁共振成像、计算机断层扫描或随访骨扫描）的检查结果。我们发现，SPET显示的椎弓根受累情况是椎骨转移瘤的一项准确诊断标准。SPET的敏感性为87%，特异性为91%，阳性预测值为82%，阴性预测值为94%，准确性为90%。另一方面，平面研究在诊断椎骨转移瘤时的敏感性为74%，特异性为81%，阳性预测值为64%，阴性预测值为88%，准确性为79%。除阴性预测值外，SPET在统计学上比平面成像表现更好。随后仅发现147例中9例（6.4%）仅累及椎体的病变以及49例中3例（6.1%）仅累及小关节的病变为转移瘤。我们得出结论，骨SPET是检测椎骨转移瘤的一项准确诊断检查，在这方面优于平面成像。
