摘要目的 探讨SPECT/CT融合显像在单个股骨头颈部或转子区病变诊断中的应用价值.方法 在2007年1月至2008年6月进行99Tcm-亚甲基二膦酸盐(MDP)全身骨显像的患者中,94例股骨头颈或转子区异常放射性分布不能明确诊断,遂行SPECT/CT显像,并通过随访得到患者的病理诊断或综合影像诊断.对病变的SPECT图像、CT图像及SPECT/CT融合图像的诊断符合率进行对比,并分析转移性肿瘤及良性病变的影像特征.采用SPSS 13.0软件行McNemar检验.结果 排除失访及最后未明确诊断者,最终入选患者78例.根据随访结果,确定良性病灶59例,转移性肿瘤19例.SPECT、CT及融合图像对78例病灶的诊断符合率分别为59.0%(46/78),87.2%(68/78),96.2%(75/78),SPECT、CT图像分别与融合图像比较,差异均有统计学意义(X2=16.48和48.18,P均＜0.05).结论 在对肿瘤患者进行骨显像中发现的股骨头颈或转子区病变以良性病变居多,SPECT/CT融合显像可提高其诊断准确性.

abstractsObjective The study was aimed to evaluate the value of SPECT/CT in assessment of femoral foci of abnormal bone metabolism classified as indeterminate on bone scanning using 99Tcm-methylene diphosphonate(MDP).Methods There were 94 patients with solitary femoral abnormal uptake in bone scanning included.SPECT was accompanied by inline CT over the femoral region.All of the images were blindly interpreted independently by two experienced board-certified radiologists.The reference standard was follow-up over half a year of MRI,CT,SPECT,or pathology.Diagnoses which consist with reference were counted as accurate.Diagnoses which either not consist with reference or undetermined were counted as false.McNemar test was used for data analysis.Results of the 94 patients,78 patients(male 42,female 36,mean age 62 years) had definite diagnosis;19 were malignant and 59 were benign diseases.The diagnostic accuracy by bone SPECT,bone CT was significantly lower than fusion imaging[58.9%(46/78),87.2%(68/78),96.2%(75/78),respectively,X2=16.48,48.18,both P＜0.05].Conclusions Most of the solitary femoral foei caused by benign diseases.SPECT/CT using 99Tcm-MDP has additional value than with SPECT or CT alone in differentiating malignancy from benignancy in femoral foci.