Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer
Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer
复制标题
DOI：
10.1007/s00259-005-1842-8
复制
发表时间：
2005-11-01
影响因子：
9.1
通讯作者：
Nishimura, T
中科院分区：
文献类型：
--
作者：
Nakai, T;Okuyama, C;Nishimura, T
目的：本研究的目的是通过与Tc-99 m-羟基亚甲基二磷酸盐骨闪烁扫描进行比较，探讨使用2-[F-18]-氟-2-脱氧-D-葡萄糖正电子发射断层扫描（FDG-PET）评估乳腺癌患者成骨细胞骨转移的缺陷。方法：在2003年9月至2004年12月的1个月内接受FDG-PET和骨显像的89例乳腺癌患者（平均年龄59 ± 15岁）中，研究了55例骨转移。根据成骨细胞、溶骨细胞、混合型和非成骨细胞4种类型的骨转移瘤，通过多层CT进行直观分类，并比较FDG-PET或骨显像的示踪剂摄取和FDG-PET的SUV均值。结果：骨显像诊断乳腺癌的敏感性、特异性和准确性分别为78.2%、82.4%和79.8%，FDG-PET诊断乳腺癌的敏感性、特异性和准确性分别为80.0%、88.2%和83.1%，两组间差异无统计学意义。骨显像/FDG-PET显像显示率：原始型100%/55.6%，溶解型70.0%/100.0%，混合型84.2%/94.7%，隐匿型25.0%/87.5%。原始型的骨显像和不可见型的FDG-PET显像的显像率显著较高。母细胞型、溶解型、混合型和不可见型的SUV平均值分别为1.72 +/- 0.28、4.14 +/- 2.20、2.97 +/- 1.98和2.25 +/- 0.80，表明溶解型的SUV平均值往往高于母细胞型。FDG-PET显示成骨细胞骨转移的显像率较低。尽管FDG-PET可用于检测乳腺癌骨转移，但很明显，它在描述成骨细胞型转移方面存在一些局限性。
Purpose: The purpose of this study was to investigate the pitfalls of using 2-[F-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for the evaluation of osteoblastic bone metastases in patients with breast cancer by comparing it with Tc-99m-hydroxymethylene diphosphonate bone scintigraphy.Methods: Among the 89 breast cancer patients (mean age 59 +/- 15 years) who had undergone both FDG-PET and bone scintigraphy within 1 month between September 2003 and December 2004, 55 with bone metastases were studied. The bone metastases were visually classified by multi-slice CT into four types according to their degree of osteosclerosis and osteolysis-osteoblastic, osteolytic, mixed and invisible-and compared in terms of tracer uptake on FDG-PET or bone scintigraphy and SUVmean on FDG-PET. Differences in the rate of detection on bone scintigraphy and FDG-PET were analysed for significance by the McNemar test.Results: The sensitivity, specificity and accuracy of bone scintigraphy were 78.2%, 82.4% and 79.8% respectively, and those of FDG-PET were 80.0%, 88.2% and 83.1%, respectively, revealing no significant differences. According to the CT image type, the visualisation rate of bone scintigraphy/FDG-PET was 100%/55.6% for the blastic type, 70.0%/100.0% for the lytic type, 84.2%/94.7% for the mixed type and 25.0%/87.5% for the invisible type. The visualisation rates of bone scintigraphy for the blastic type and FDG-PET for the invisible type were significantly higher. The SUVmean of the blastic, lytic, mixed and invisible types were 1.72 +/- 0.28, 4.14 +/- 2.20, 2.97 +/- 1.98 and 2.25 +/- 0.80, respectively, showing that the SUVmean tended to be higher for the lytic type than for the blastic type.Conclusion: FDG-PET showed a low visualisation rate in respect of osteoblastic bone metastases. Although FDG-PET is useful for detection of bone metastases from breast cancer, it is apparent that it suffers from some limitations in depicting metastases of the osteoblastic type.