| Objective:Quantitative SPECT/CT(xSPECT Bone)is an emerging high-definition bone imaging technology that can quantify the metabolic level of bone and express it using standardized uptake value(SUV),realizing the leap from bone imaging from visual analysis to quantitative diagnosis.In this study,the maximum standardized uptake value(SUVmax)of Bone metastases,benign lesions and normal bone in lung cancer patients was calculated using quantitative bone SPECT/CT(xSPECT Bone)technology,and the optimal diagnostic threshold was sought,to investigate the diagnostic value of SUVmax in bone metastasis of lung cancer.Methods:Retrospective analysis was performed on patients with pathologically confirmed lung cancer and clinically suspected bone metastasis who received SPECT/CT radionuclide bone imaging in the Department of Nuclear Medicine of our hospital from June 2021 to August 2022.Bone metastases,benign lesions and SUVmax of normal bone in the control group were obtained by xSPECT Bone technique.IBM SPSS 25.0 software was used for statistical analysis to analyze the correlation between SUVmax value of bone metastases and clinical factors(site of bone metastases,type of bone metastases,pathological type of lung cancer),the measurement data are non-normaldistribution,expressed by mean±standard,Mann-Whitney U test was used to compare the non-normally distributed data of the two groups,and Kruskal-Wallis H test was used to compare the non-normally distributed data of more than three groups.Receiver operating characteristic curve(ROC)was used to calculate the optimal diagnostic threshold of SUVmax.The test level(a)was 0.05.Results:1.A total of 45 patients with bone metastases of lung cancer were found,including 33 cases(73.3%)of lung adenocarcinoma,8 cases(17.8%)of lung squamous cell carcinoma,and 4 cases(8.9%)of small cell lung cancer.A total of 241 bone metastases were diagnosed,of which 117(48.6%)were located in the spine,50(20.7%)in the thoracic bone(ribs,sternum,clavicle,scapula),50(20.7%)in the pelvis,20(8.3%)in the limb bone,and 4(1.7%)in the skull.Among the 241 bone metastases of lung cancer,128(53.1%)were osteoblastic metastases,89(36.9%)were osteolytic metastases,and 24(10.0%)were mixed metastases.46 benign lesions were found,including 24 cases of osteoarthritis,12 cases of degeneration,8 cases of fracture and 2 cases of endlaminitis.2.Among the bone metastases in different parts,the SUVmax(mean±SD)in the spinal group,thoracic bone group(ribs,sternum,collarbone,shoulder blade),pelvic group,limb bone group and skull group were 23.58±15.17g/ml,20.33±15.84g/ml,24.04±13.34g/ml,24.05±16.99g/ml,9.93±4.36g/ml,there was no statistically significant comparison between the groups(P>0.05).Among different pathological types of lung cancer,the SUVmax of bone metastases of lung adenocarcinoma,lung squamous cell carcinoma and small cell lung cancer were 22.20±13.47g/ml,28.26±21.66g/ml and 15.32±7.77g/ml,and there was no significant differencebetween groups(P>0.05).Among the different types of bone metastasis,the SUVmax of osteolytic,osteogenic and mixed bone metastases were 21.49±16.79g/ml,23.80±14.05g/ml,22.44±13.54g/ml,there was no statistically significant comparison between the groups(P>0.05).3.The SUVmax of bone metastasis,benign lesion and normal bone were 22.81±15.05g/ml,10.39±5.87g/ml and 5.42±2.46g/ml,respectively.The SUVmax of the lesion group(bone metastases+benign lesions)was 20.82±14.71g/ml,higher than that of the normal bone,the difference was statistically significant(P<0.05).ROC curve analysis showed that the optimal diagnostic threshold of bone lesions was SUVmax≥8.85g/ml,and the area under the curve was 0.941.The diagnostic sensitivity and specificity were 82.2%and 93.4%respectively.In the lesion group,the SUVmax of bone metastases was higher than that of benign lesions,and the difference was statistically significant(P<0.05).ROC curve analysis showed that the optimal diagnostic threshold for differentiating bone metastases from benign lesions was SUVmax≥12.75g/ml,and the area under the curve was 0.808.the diagnostic sensitivity and specificity were 70.1%and 80.4%.Conclusion:1.The SUVmax of lung cancer bone metastases was 22.81±15.05g/ml,the range of SUVmax was the same among different bone metastases sites,types of bone metastases and pathological types,indicating that bone quantitative SPECT/CT has good consistency and repeatability in the detection of lung cancer bone metastases.2.ROC curve analysis showed that SUVmax≥8.85g/ml was the best diagnostic threshold for bone lesions in lung cancer patients,with sensitivity and specificity of 82.2%and 93.4%.The SUVmax of bone metastases was higher than that of benign lesions,and SUVmax≥12.75g/ml was the best diagnostic threshold for the differentiation between bone metastases and benign lesions,with the sensitivity and specificity of 70.1%and 80.4%.SUVmax in quantitative SPECT/CT can be used as an important auxiliary diagnostic basis for bone metastasis of lung cancer.3.Lung adenocarcinoma is more common in patients with lung cancer bone metastasis,the metastasis site is mainly the spine,followed by the thoracic bone and pelvis. |
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