Clinical Value Of Three Phase Bone Scintigraphy Combined With SPECT/CT Fusion Imaging For Differential Diagnosis Of Benign And Malignancy Bone Lesion

Objective: This study discussed three aspects of the research purposes.At first,one purpose was to discuss the clinical value of three phase scintigraphy combined with SPECT/CT fusion imaging for differential diagnosis of benign and malignancy skeletal lesions.Furthermore,we wanted to gain the semi-quantitative analysis parameters and numerical values of three phase scintigraphy,to identify which of them had the highest diagnosis efficacy.Finally,we combined the three phase bone scintigraphy semi-quantitative analysis with SPECT/CT fusion imaging to find the added clinical value of this imaging method for differential diagnosis of benign and malignancy skeletal lesions.Methods:1.Objective: In this study,a total of 70 patients with bone lesions were collected to use for three-phase bone imaging combined with SPECT/CT fusion imaging.Among them,3patients were examined twice before and after,and 1 patient underwent 3 tests,so 75 times tests were made.2.Examination methods:(1)On the basis of the different image processing methods,each examination produced two methods.First,the 75 person-time examinations used the planar bone imaging combine with CT fusion imaging,which was called pure SPECT/CT fusion imaging.Another method was to using three phase bone imaging combined with SPECT/CT fusion imaging.The two methods of examination were independently and blinded by two experienced nuclear physicians to diagnose their benign or malignant.(2)Delineate the interest area of the three-phase bone imaging to generate the time-radiation curve and the numerical value of each semi-quantitative parameter index.3.Statistical analysis: Compared the diagnostic efficacy of two examination methods in differentiating benign and malignant skeletal diseases,and tested the consistency between the two groups of diagnoses and the final diagnosis.Compared the diagnosis efficacy of the semi-quantitative analysis parameters of three phase scintigraphy,and explored the optimal diagnostic cutoff point and index.Obtained the diagnosis efficacy by applying the best semi-quantitative analysis parameters to three phase bone scintigraphy combined with SPECT/CT imaging.Results: In the 70 patients,there were 75 times examination were produced.The age range of the patients was 12 to 83 years old.The patients' average age was 52.8 years old.Among the 75 times examination,18 were malignant and 57 were benign.26 patients were finded have primary malignant tumor,some of this patients had a malignant bone tumor resection.In addition to the 39 cases was diagnosed by pathology,the other cases were confirmed by follow-up.1.The accuracy rate,sensitivity,specificity,malignant misdiagnosis rate,malignant missed diagnosis,malignant predictive value,positive predictive value of three-phase bone scintigraphy in combination with SPECT/CT fusion imaging to identify benign and malignant bone lesions respectively were: 94.74%,96.43%,96%,5.3%,3.6%,90%,1.8%;simultaneously,the information of the single SPECT/CT fusion imaging group were: 89.47%,91.07%,90.67%,10.5%,8.9%,77.3%,3.8%.The sensitivity,specificity and accuracy of the two methods were statistically significant(P < 0.05).2.According to the consistency analysis of the two examination methods and the final diagnosis: the Kappa value of three-phase bone imaging combined SPECT/CT fusion imaging was 89.6%;the Kappa value of single SPECT/CT fusion imaging was 76.6%.3.In three-phase bone scintigraphy index of semi-quantitative analysis,expect the peak time of benign side had not take obvious long time for malignant side,the rest index of benign side were all significantly lower than the malignant side,and the differences were statistically significant(P < 0.05).4.The area under the radioactive-time curve of differential diagnosis of benign and malignancy bone lesion in highest radioactive count rate,average count,area under the radioactive-time curve,the slope of radioactive-time curve,blood pool phase radioactivity uptake ratio,delay phase radioactivity uptake ratio and time to peak count rate respectively were: 0.675,0.746,0.698,0.707,0.597,0.624,0.652.The average count and the radiation-time curve slope had a higher diagnosis value in the semi-quantitative analysis parameters(AUC* > 0.7),and the best diagnostic cutoff point was 4.8 and 2.67 respectively.5.By referring to average count as the optimal semi-quantitative analysis parameter,the three phase scintigraphy combined with SPECT/CT fusion imaging enhance the diagnostic accuracy to 98.67%;by taking the slope of radioactive-time curve as a reference,the diagnostic accuracy was enhanced to 98.67%.Conclusions:1.The diagnosis value of three-phase bone imaging combined SPECT/CT fusion imaging was significantly higher than the pure SPECT/CT fusion imaging for differential diagnosis of the benign and malignant skeletal lesions.2.The semi-quantitative parameters which have a higher diagnosis value from the others is the average count and the slope of radioactive-time curve.According to the research data,the best diagnostic cutoff point of this parameters are 4.8 and 2.67,respectively.3.With the average count or the slope of radioactive-time curve taking as the optimal semi-quantitative analysis parameter,the three phase scintigraphy combined with SPECT/CT fusion imaging got a higher accuracy of the diagnosis result from three-phase bone scintigraphy in combination with SPECT/CT fusion imaging without the semi-quantitative analysis parameter.