Clinical Research On Single Lesion In Radionuclide Bone Imaging

BackgroundRecent years, the morbidity of different tumors has been increasing year by year, and it is dangerous threat to human health. Clinically, most malignant tumor with the important factor bringing the death is the tumor metastasis. Furthermore, bone metastasis is the main metastatic way of malignant tumor, especially advanced malignant tumor. The bone metastatic cancer not only increases the mortality of patients in advanced malignant tumor. However, the complications such as acute bone pain have great affected the patients’ life quality. It is important to identify the bone metastatic cancer early. Identified bone metastatic cancer by imaging diagnosis is a effective way, and the popular ways of imaging diagnosis are X-ray, CT, MR and radionuclide bone imaging. Compared with other imaging diagnosis, radionuclide bone imaging can diagnosis bone lesion early. However, this way has poor specificity and is difficult to check the benign or malignant of single lesion. In order to play full use of the advantages of radionuclide bone imaging in finding the lesion in early stage, the judgment of benign or malignant of single lesion is extremely important. PurposeRetrospective analyze the image features, general distribution of single lesion in radionuclide bone imaging, Discusses the value of bone imaging when identifying benign or malignant of single lesion. The correlation between benign or malignant of single lesion and different characteristic factors will be discussed, and we compare the differences of correlation between different factors and benign or malignant of single lesion. In addition, the paper studied the correlation between L/N value(lesion/ non-lesion value) and benign or malignant of single lesion. Materials and methods1、The whole distribution analysis of single lesion in radionuclide bone imaging: Picking up 1062 clinical patients to make retrospective analysis, and analyze the whole distribution features of single lesion. And the research studies the features of some aspects such as primary tumor, lesion location, and lesion type etc of 451 patients with benign or malignant can be identified. The distribution features of benign or malignant lesion in main bones will be analyzed.2、Evaluate the value of identifying the benign or malignant of single lesion through radionuclide bone imaging by Logistic regression model: to build a Logistic regression model and evaluate the prediction ability, the benign or malignant of single lesions will be taken as dependent variable, and the gender, age, lesion form, degree of radioactivity concentration in lesion, the osteolytic changes lesion, lesion location and primary tumor will be taken as independent variables.3、The analysis on correlation between the value of L/N and the property of single lesion: We made semi-quantitative analysis on the single lesion which was found by bone imaging by using ROI(region of interest), and calculated the value(L/N) between the RIO value in single lesion region and the RIO value in non-lesion regions. The single lesion from 255 patients who had been identified and meanwhile done by X-ray(plan film or CT) in 2 weeks was divided into 4 groups. The group 1 are degenerative changes lesions, the group 2 are other benign lesions, group 3 are fracture lesions and group 4 are malignant lesions. Comparing and analyzing the differences of L/N value among different groups, and the correlation between the L/N value and benign or malignant of single lesion. Result1、The general distribution of single lesion in radionuclide bone imaging(1) The form of Single lesion is divided into dot, crumby structure, Large sheet, Streak and ring.(2) Within the 1062 single lesions, skull6.8%, thoracic bone37.2%(clavicle4.2%, shoulder blade1.6%, sternum3.1%, the ribs28.2%), backbone22.8%, pelvis14.1%, bone of the extremities19.1%.(3) In the identified lesions, skull 5.1%, malignant rate 8.7%. Thoracic bone 40.8%, malignant rate 14.1%. Backbone 24.4%, malignant rate 21.8%. Pelvis 11.3%, malignant rate 35.3%. Bones of the extremities 18.4%, malignant rate 25.3%.(4) In the identified lesions, dot 53.7%, malignant rate 4.5%. crumby structure 19.1%, malignant rate 18.6%. Large sheet 9.1%, malignant rate 36.6%. Streak 14.6%, malignant rate 50%. Ring(osteolytic bone) 3.5%, malignant rate 100%.(5) In the identified lesions, lung cancer 24.2%, malignant rate 28.4%. Breast cancer 25.3%, malignant rate 12.3%. Prostatic cancer 10.9%, malignant rate 26.5%.2、Evaluate value of identifying the benign or malignant of single lesion through radionuclide bone imaging by Logistic regression modelBy Logistic regression analysis, the lesion form X3, degree of radioactivity concentration in lesion X4 and primary tumor X7 has statistical significance, the Logistic regression model as follows:Logit(p)=-4.731+0.862X3+0.609X4+0.153X7We check likelihood ratio of this model, X2=96.464,P=0.000, it means this model has statistical significance. Accuracy predicting the malignant lesion is 28.6%, predicting benign lesion is 93.1% and the whole prediction rate is 80%. the area under ROC curve is 0.6, 95% confidence interval(0.538, 0.678).3、Correlation between the value of L/N and the property of single lesionThe one-way analysis of variance shows the significant differences of L/N value in different groups(F=48.77 P=0.000). The results of comparison between any two groups suggest that: the difference of L/N value between group 1(lesion group with degenerative change) and group 2(other benign lesion groups) are not significant(P>0.05). The differences of L/N value between group 1 and group 3(bone fracture lesion group) or group 4(malignant lesion group), group 2 and group 3 or group 4, group 3 and group 4 are significant(P=0.000).Conclusion1、The parts on skull, clavicle and shoulder blade, especially the distant lesion on the clavicle; The dot or crumby structure lesion on the junction of manubrium and mesosternum, the lesion on junction of costicartilage, the dot lesion on non-costicartilage junction, the dot or massive lesion on lower lumbar and dot lesion on sacroiliac joint, they get great possibility to be benign lesion.2 、 Streak lesion of mesosternum, streak lesion on non-costicartilage junction, crumby structure lesion on thoracic vertebra and upper lumbar have greater possibility of malignance.3、Compared with other characteristic variables, lesion form, degree of radioactivity concentration in lesion and the possibility of primary tumor exists have greater positive correlation in diagnosing the benign or malignant of single lesion. The possibility single lesion is identified to be benign if their morphology expresses to be dot and crumby structure, low degree of radioactivity concentration, no primary tumor exists.4、Besides the bone fracture, the L/N value of benign lesion is the lowest, the L/N value of malignant lesion is medium high, and the L/N value of bone fracture lesion is the highest. Therefore, the L/N value embraces certain reference value to the judgment of benign or malignant single lesion.