摘要
目的 分析18F-氟化钠(NaF)PET/CT全身骨显像中骨转移瘤最大标准化摄取值(SUVmax)的相关影响因素.方法 回顾性分析2020年8月至2022年12月在桂林医学院附属医院行18F-NaF PET/CT全身骨显像并经临床确诊为恶性肿瘤骨转移患者233例,其中男性113例、女性120例,年龄(57.9±10.7)岁.临床确诊包括临床资料、其他影像检查[CT、MR1、99Tcm-亚甲基二膦酸盐SPECT/CT、18F-氟脱氧葡萄糖PET/CT]和组织病理学检查.分析骨质破坏类型、骨转移瘤部位、原发恶性肿瘤、有无治疗史等因素与骨转移瘤SUVmax的关系.根据是否行抗肿瘤治疗将患者分为治疗组、未治疗组.2组间比较采用两独立样本t检验、校正t检验和Mannu-Whitney U检验,多组间比较采用单向方差分析.结果 233例恶性肿瘤骨转移患者共发现2737个病灶.全身各部位骨转移发生率由高到低依次为脊柱骨41.1％(1 126/2 737)、胸部骨 26.1％(714/2 737)、骨盆骨 20.9％(571/2 737)、四肢骨 7.0％(192/2 737)、颅骨 4.9％(134/2 737).根据骨转移瘤骨质破坏类型进行分析,混合型病变的SUVmax高于溶骨型及成骨型,且差异有统计学意义(22.8对19.7对16.7,Z=5.323、7.160,均P＜0.001);根据骨转移瘤发生部位进行分析,其SUVmax从高到低依次为骨盆骨21.8(15.5,31.7)、脊柱骨21.6(15.0,32.0)、四肢骨19.4(13.6,29.1)、胸部骨(包括锁骨、肩胛骨、胸骨及肋骨)17.4(12.6,24.2)和颅骨14.8(11.4,19.3).针对原发恶性肿瘤进行比较,小细胞肺癌、胃癌、直肠癌、鼻咽癌的骨转移瘤SUVmax高于其他恶性肿瘤.未治疗组恶性肿瘤骨转移SUVmax高于治疗组,且差异有统计学意义[22.0(15.1,32.5)对 18.9(13.5,28.9),Z=6.005,P＜0.001].结论 18F-NaF PET/CT 全身骨显像中骨转移瘤SUVmax与骨质破坏类型、骨转移瘤部位、原发恶性肿瘤及有无治疗史等因素有关.
Abstract
Objective The factors related to the maximum standardized value(SUVmax)of bone metastases in 18F-sodium fluoride(NaF)PET/CT whole-body bone imaging were analyzed.Methods A retrospective analysis was performed on 233 patients who underwent 18F-NaF PET/CT whole-body bone imaging in the Affiliated Hospital of Guilin Medical College from August 2020 to December 2022 and were clinically diagnosed as malignant tumor with bone metastases,including 113 males and 120 females,aged(57.9±10.7)years.Clinical diagnosis included clinical data,other imaging examinations(CT,MRI,99Tcm-methylenediphosphonate SPECT/CT,18F-fluorodeoxyglucose PET/CT)and histopathology.We analyzed the relationship between type of bone destruction,the parts of bone metastasis,the primary malignant tumor,the history of treatment and SUVmax of bone metastases.The patients were divided into treated group and untreated group according to whether they received antitumor therapy.Two independent sample t-test,corrected t-test and Mannu-Whitney U test were used for comparisons between the two groups,and one-way analysis of variance was used for comparisons between multiple groups.Results A total of 2 737 bone metastases were found in 233 patients with malignant tumor.The incidence of bone metastasis in all parts of the body varied from high to low as follows:spine bone 41.1％(1 126/2 737),chest bone 26.1％(714/2 737),pelvic bone 20.9％(571/2 737),quadrilateral bone 7.0％(192/2 737),and skull 4.9％(134/2 737).Analysis of the type of bone destruction in bone metastases revealed that the SUVmax of mixed type was higher than that of osteolytic and osteogenic types,and the difference was statistically significant(22.8 vs.19.7 vs.16.7;Z=5.323,7.160;both P＜0.001).When analyzed according to the parts of bone metastases,SUVmax decreased in the following order:pelvic bone 21.8(15.5,31.7),spine bone 21.6(15.0,32.0),quadrilateral bone 19.4(13.6,29.1),chest bone(including clavicle,scapula,sternum,and ribs)17.4(12.6,24.2),and skull 14.8(11.4,19.3).In terms of primary malignant tumors,small cell lung cancer,gastric cancer,rectal cancer,and nasopharyngeal carcinoma had higher SUVmax values than other malignant tumors.The SUVmax of bone metastasis from malignant tumor in the untreated group was higher than that in the treated group,and the difference was statistically significant[22.0(15.1,32.5)vs.18.9(13.5,28.9);Z=6.005;P＜0.001].Conclusion The SUVmax of bone metastases in 18F-NaF PET/CT whole-body bone imaging was related to the type of bone destruction,parts of bone metastases,primary malignant tumor,and the history of treatment.
万方数据