PurposeTo assess the utility of skeletal standardized uptake values (SUVs) obtained using quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) in differentiating bone metastases from benign lesions, particularly in patients with lung adenocarcinoma.MethodsPatients with lung adenocarcinoma who had undergone whole-body Tc-99m methyl-diphosphonate (99mTc-MDP) bone scans and received late phase SPECT/CT were retrospectively analyzed in this study. The maximum SUV (SUVmax); Hounsfield units (HUs); and volumes of osteoblastic, osteolytic, mixed, CT-negative metastatic and benign bone lesions, and normal vertebrae were compared. Receiver operating characteristic curves were used to determine the optimal cutoff SUVmax between metastatic and benign lesions as well as the cutoff SUVmax between CT-negative metastatic lesions and normal vertebrae. The linear correlation between SUVmax and HUs of metastatic lesions as well as that between SUVmax and the volume of all bone lesions were investigated.ResultsA total of 252 bone metastatic lesions, 140 benign bone lesions, and 199 normal vertebrae from 115 patients with lung adenocarcinoma were studied (48 males, 67 females, median age: 59 years). Metastatic lesions had a significantly higher SUVmax (23.85 ± 14.34) than benign lesions (9.67 ± 7.47) and normal vertebrae (6.19 ± 1.46; P < 0.0001). The SPECT/CT hotspot of patients with bone metastases could be distinguished from benign lesions using a cutoff SUVmax of 11.10, with a sensitivity of 87.70% and a specificity of 80.71%. The SUVmax of osteoblastic (29.16 ± 16.63) and mixed (26.62 ± 14.97) lesions was significantly greater than that of osteolytic (15.79 ± 5.57) and CT-negative (16.51 ± 6.93) lesions (P < 0.0001, P = 0.0003, and 0.002). SUVmax at the cutoff value of 8.135 could distinguish CT-negative bone metastases from normal vertebrae, with a sensitivity of 100.00% and a specificity of 91.96%. SUVmax showed a weak positive linear correlation with HUs in all bone metastases and the volume of all bone lesions.ConclusionSUVmax of quantitative SPECT/CT is a useful index for distinguishing benign bone lesions from bone metastases in patients with lung adenocarcinoma, particularly in the diagnosis of CT-negative bone metastases, but other factors that may affect SUVmax should be considered.

目的:探讨放射性碘治疗(RAI)中131I治疗分化型甲状腺癌(DTC)功能性肺转移的短期疗效及其影响因素.方法:分析在医院行RAI的16例发生功能性肺转移的DTC患者,所有患者均行131I治疗,每次131I治疗前1月内行颈部超声、胸部CT检查,治疗前3～4 d测定血清甲状腺功能的T3、T4、FT3、FT4、Tg、抗甲状腺球蛋白抗体(TgAb)和促甲状腺激素(TSH)水平,131I治疗后5～7 d行131I单光子发射型电子计算机断层扫描/CT(SPECT/CT),治疗后2～3个月后复查并进行疗效评估,根据131I治疗的功能性肺转移的短期疗效将16例患者分为完全缓解(CR)组(11例),部分缓解(PR)组(4例),无效(NR)组(1例),并且分析不同疗效的影响因素.结果:在行131I治疗的16例功能性肺转移的DTC患者中,CR组11例,PR组4例,NR组1例.16例功能性肺转移DTC患者治疗总有效率为93.75％(15/16).3组末次手术与首次131I治疗间隔、肺外转移情况及首次131I治疗前血清Tg水平比较,差异有统计学意义(x2=4.535,x2=6.541,x2=5.403;P<0.05).病理类型、性别、诊断DTC时年龄、有无甲状腺外侵犯、有无甲状腺被膜外纤维组织和横纹肌侵犯、有无神经侵犯、有无脉管瘤栓和淋巴结转移个数、手术次数、131I治疗次数及131I累积剂量在3组间差异无统计学意义.结论:RAI是治疗DTC患者术后发生功能性肺转移的有效方法,患者短期治疗疗效良好.131I的治疗疗效与末次手术与首次131I治疗间隔时间、肺外转移情况以及首次131I治疗前Tg水平相关.

目的:研究分化型甲状腺癌(DTC)术后首次131I治疗前,在停服甲状腺激素状态下的DTC刺激性甲状腺球蛋白(ps-Tg)、ps-Tg与促甲状腺激素(TSH)比值(ps-Tg/TSH比值)在预测转移中的价值.方法:选取在医院诊治中行甲状腺全切术+颈部淋巴结清扫术的261例DTC患者,根据癌有无转移,将其分为转移(M1)组(157例)和未转移(M0)组(104例).两组患者首次131I治疗前4 d测定血清ps-Tg、ps-Tg/TSH比值水平,131I治疗后5～7 d行131I全身显像及SPECT/CT断层显像.比较两组间的ps-Tg、ps-Tg/TSH比值水平的差异,用受试者工作特征(ROC)曲线下面积(AUC)及最佳临界值点(DCP)评估ps-Tg、ps-Tg/TSH比值对预测转移的价值.结果:M0组的ps-Tg和ps-Tg/TSH比值中位数M及五分位数间距(P5-P95)分别为2.83 ng/ml(0.119.35 ng/ml)和0.03 ng/μIU(0.000.10 ng/μIU);M1组分别为45.36 ng/ml(2.85153.05 ng/ml)和0.46 ng/μIU(0.029.17 ng/μIU),两组比较差异均有统计学意义(U=1310,U=1511;P<0.05).ps-Tg和ps-Tg/TSH比值预测淋巴结远处转移的AUC分别为0.92和0.91,最佳DCP分别为11.15 ng/ml和0.12 ng/μIU;ps-Tg和ps-Tg/TSH比值预测转移的灵敏度和特异度分别为80.2％、99.0％和82.0％、97.0％.ps-Tg、ps-Tg/TSH比值预测颈部淋巴结转移的AUC分别为0.67和0.66,最佳DCP分别为2.70 ng/ml和0.03 ng/μIU,灵敏度为98.0％和89.8％,特异度为87.8％和76.4％.预测远处转移的AUC分别为0.94和0.94,最佳DCP为15.38 ng/ml和0.16 ng/μIU,灵敏度为90.90％和90.90％,特异度为88.30％和87.40％.结论:DTC患者术后首次131I治疗前ps-Tg、ps-Tg/TSH比值对术后转移有较好的预测价值.