Comparison of diffusion-weighted whole body MRI and skeletal scintigraphy for the detection of bone metastases in patients with prostate or breast carcinoma
Comparison of diffusion-weighted whole body MRI and skeletal scintigraphy for the detection of bone metastases in patients with prostate or breast carcinoma
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DOI：
10.1007/s00256-009-0789-4
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发表时间：
2010-04-01
影响因子：
2.1
通讯作者：
Binkert, Christoph A.
中科院分区：
文献类型：
--
作者：
Gutzeit, Andreas;Doert, Aleksis;Binkert, Christoph A.
为了前瞻性地比较全身弥散加权成像与背景全身信号抑制(DWIBS)和骨骼核素扫描对前列腺癌或乳腺癌患者骨骼病变的诊断和鉴别诊断的准确性。对36例患者进行了骨骼核素扫描和1.5T DWIBS磁共振成像。根据形态和信号强度模式，两个阅读器各自独立地识别并在盲目条件下将所有病变分为三组：(1)恶性，(2)不清楚是恶性还是良性，(3)良性。最后，对于黄金标准的定义，考虑了所有可用的成像技术和至少6个月的随访，总共发现了45个局限性骨转移和107个良性病变。在发现10个以上病变的患者中，DWIBS诊断恶性骨骼病变的灵敏度(灵敏度：0.97/0.91)明显优于骨骼核素扫描(灵敏度：0.48/0.42)。DWIBS(0.58/0.33)和骨显像(0.67/0.58)对小于5个病灶的恶性骨骼病变的敏感度差异无统计学意义。对于良性病变，核素扫描的灵敏度最高，为0.93/0.87，而DWIBS的灵敏度为0.20/0.13。观察者间对Cohen‘s kappa系数的一致性在核素扫描的情况下为0.784，在DWIBS的情况下为0.663。在前列腺癌和乳腺癌的分期方面，DWIBS技术并不优于骨骼核素扫描，但同等重要。然而，在有许多骨病变的病例中，使用DWIBS技术可以明显比骨骼核素扫描发现更多的转移瘤。
To prospectively compare the diagnostic accuracy of diffusion-weighted whole body imaging with background whole body signal suppression (DWIBS) with skeletal scintigraphy for the diagnosis and differentiation of skeletal lesions in patients suffering from prostate or breast cancer.A diagnostic cohort of 36 patients was included in skeletal scintigraphy and 1.5 T DWIBS MRI. Based on morphology and signal intensity patterns, two readers each identified and classified independently, under blinded conditions, all lesions into three groups: (1) malignant, (2) unclear if malignant or benign and (3) benign. Finally, for the definition of the gold standard all available imaging techniques and follow-up over a minimum of 6 months were considered.Overall, 45 circumscribed bone metastases and 107 benign lesions were found. DWIBS performed significantly better in detecting malignant skeletal lesions in patients with more than 10 lesions (sensitivity: 0.97/0.91) compared to skeletal scintigraphy (sensitivity: 0.48/0.42). No statistical difference could be found between DWIBS (0.58/0.33) and skeletal scintigraphy (0.67/0.58) in the sensitivity values for malignant skeletal lesions in patients with less than 5 lesions. For benign lesions, scintigraphy scored best with a sensitivity of 0.93/0.87 compared to 0.20/0.13 for DWIBS. Interobserver agreement with Cohen's kappa coefficient was calculated as 0.784 in the case of scintigraphy and 0.663 for DWIBS.With respect to staging, in prostate and breast carcinoma, the DWIBS technique is not superior to skeletal scintigraphy, but ranks equally. However, in the cases with many bone lesions, markedly more metastases could be discovered using the DWIBS technique than skeletal scintigraphy.