摘要目的 采用ROC曲线比较18F-FDG PET/CT、99Tcm-MDP骨显像及二者联合对骨转移患者的检出效能.方法 296例恶性肿瘤患者在2个月内同时接受了18F-FDG PET/CT和99Tcm-MDP骨显像,对2种显像结果 按5分法(0分:骨转移阴性,1分:可能阴性,2分:不能确定,3分:可能阳性,4分:肯定阳性)分别评分,两者之和为联合评分值.以病理诊断或临床随访为确诊"金标准",采用z检验比较ROC曲线下面积,以评价骨显像、PET/CT及联合评分法对骨转移患者的检出效能,采用χ2检验比较不同方法 在各自最佳诊断阈值下的灵敏度、特异性、准确性、阳性预测值、阴性预测值.结果 296例患者中,确诊骨转移阳性61例(占20.6%)、阴性235例(占79.4%).骨显像、PET/CT及联合评分诊断骨转移的ROC曲线下面积(95%可信区间)分别为0.919(0.867～0.971)、0.949(0.906～0.991)、0.994(0.988～0.999),联合评分法的曲线下面积明显大于骨显像(z=2.866,P=0.004)和PET/CT(z=2.027,P=0.043)各自单独评分法,骨显像和PET/CT法曲线下面积差异没有统计学意义(z=0.881,P=0.378).最佳阈值点下,骨显像和PET/CT单独检出骨转移患者的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为90.2%(55/61)、85.1%(200/235)、86.1%(255/296)、61.1%(55/90)、97.1%(200/206)和88.5%(54/61)、97.0%(228/235)、95.3%(282/296)、88.5%(54/61)、97.0%(228/235),而联合评分检出的结果 分别为98.4%(60/61)、95.7%(225/235)、96.3%(285/296)、85.7%(60/70)、99.6%(225/226).PET/CT对骨转移患者检出的特异性(χ2=19.600,P<0.001)、准确性(χ2=13.755,P<0.001)、阳性预测值(χ2=13.608,P<0.001)均高于骨显像,灵敏度(χ2=0,P=1.000)差异无统计学意义;与骨显像、PET/CT单独评分比较,联合评分法检出的特异性(χ2=19.862,P<0.001)、准确性(χ2=23.361,P<0.001)和阳性预测值(χ2=11.791,P=0.001)均明显高于骨显像,灵敏度明显高于PET/CT(χ2=4.167,P=0.031).结论 18F-FDG PET/CT对骨转移患者的检出效能优于99Tcm-MDP骨显像,二者联合明显提高了对骨转移患者的检出率.

abstractsObjective To compare the efficacy of 18F-FDG PET/CT, 99Tcm-MDP bone scintigraphy (BS), and combination of the two techniques (PET/CT + BS) for detecting bone metastasis by ROC curve analysis. Methods All 296 patients with various cancers, who underwent both 99Tcm-MDP BS and 18F-FDG PET/CT within two months, were retrospectively analyzed. These images were interpreted according to 5-point scale (0: definitely negative, 1: probably negative, 2: equivocal, 3: probably positive, 4:definitely positive for bone metastasis), and the scale of PET/CT + BS was the sum of PET/CT and BS. In light of the confirmed diagnosis derived from pathology or follow-up, ROC curve analysis was performed.The area under the ROC curve (AUC) was compared by z-test. Results Of 296 cases, 61 (20.6%) were confirmed as bone metastases and 235 (79.4%) were negative. The AUC were 0. 919 (95% confidence interval (95% CI) :0. 867 - 0. 971) for BS, 0. 949 (95% CI: 0. 906 - 0. 991) for PET/CT, and 0. 994 (95% CI: 0.988-0.999) for PET/CT + BS, rctrospectively. The AUC of PET/CT + BS was statistically significantly larger than that of BS (z=2. 866, P=0.004) or PET/CT (z =2.027, P=0.043), while the AUC of PET/CT was larger than that of BS, but no statistically significance (z = 0. 881, P = 0. 378) was showed. The optimal sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value(NPV) were 90. 2% (55/61), 85. 1% (200/235), 86. 1% (255/296), 61. 1% (55/90), 97. 1%(200/206) for BS, 88.5% (54/61), 97.0% (228/235), 95.3% (282/296), 88.5% (54/61), 97.0% for PET/CT, and 98.4% (60/61), 95.7% (225/235), 96.3% (285/296), 85.7% (60/70) for PET/CT + BS,respectively. The specificity (χ2 = 19.862, P<0. 001), accuracy (χ2 = 23. 361, P<0.001) and PPV (χ2 =11. 791, P =0.001) of PET/CT + BS were significantly higher than those of BS, the sensitivity of PET/CT +BS was significantly higher than that of PET/CT (χ2 =4.167, P=0.031). Compared with BS, PET/CT had a higher specificity (χ2 = 19.600, P<0. 001), accuracy (χ2 = 13. 755, P <0. 001), PPV (χ2 = 13. 608, P <0. 001), but their sensitivity showed no statistically significant difference (χ2 = 0, P = 1. 000). Conclusions The efficacy of 18F-FDG PET/CT for detecting malignant bone metastasis was superior to that of 99Tcm-MDP BS alone. The detection ability can be obviously improved by combination of the two techniques.