| BACKGROUND1.18F-FDG PET/CT diagnosis of suspicious bone lesionsSystemic 18F-FDG PET/CT has become a relatively traditional evaluation method,which is often used to distinguish malignant tumors,inflammatory diseases and infectious diseases in clinical practice.It helps clinicians to assess and manage patients with bone tumors(primary or metastatic)for initial staging,treatment evaluation,and follow-up.Several studies have emphasized the diagnostic value of 18F-FDG PET/CT in the detection of bone lesions,but the sample size is small,and few studies have compared the diagnostic value of 18f-fdg PET/CT with the pathological results.2.18f-fdg PET/CT was used to determine the puncture target of bone lesionsHistological diagnosis of bone lesions is the most accurate method for the diagnosis of pathology.Clinically,CT-guided bone biopsy is more widely used,however,the disadvantage is that the amount of tissue obtained is limited and sampling error may occur.18f-fdg PET/CT can detect some lesions that are rarely or not shown on CT,and the effect of the puncture point on the detection rate of malignant tumor in CT-guided bone biopsy is still unclear.3.Correlation between SUV value and ADC value in bone lesionsThe standard 18F-FDG PET/CT value(SUV)represents the glucose metabolism level of cells,the glucose metabolism level of tumor cells was higher than that of normal cells.Therefore,the increase of SUV value was correlated with the degree of tumor lesions.The WB-DWI reflected the degree of tumor lesions through the value of apparent dispersion coefficient(ADC).At present,the correlation between the two indexes and bone lesions has not been reported.METHODS(1)Retrospective cohort analysis was performed on patients with suspected malignant bone lesions who received both 18F-FDG PET/CT and pathological examination from December 2010 to May 2018.The positive predictive value(PPV)of 18F-FDG PET/CT for bone malignant tumor was calculated,and the consistency of 18F-FDG PET/CT examination and pathological examination was compared.The clinical characteristics of benign and malignant bone lesions were recorded by imaging examination.(2)From December 2016 to January 2019,we prospectively evaluated 526 patients with suspected malignant bone lesions who underwent CT-guided bone biopsy,and finally included 300 patients in this study,150 patients received bone biopsy based on 18F-FDG PET/CT images and 150 patients received bone biopsy based on 18F-FDG PET/CT images.The technical feasibility,puncture results and complication rate of patients in the two groups were evaluated.The diagnosis rate of malignant tumors in the two groups was calculated,and the impact of 18F-FDG PET/CT on bone biopsy was analyzed.(3)30 cases were randomly selected from 150 patients(PET group)who received 18F-FDG PET/CT images to determine the puncture site.Before puncture,WB-DWI imaging was performed and the ADC value of the corresponding puncture site was measured.The optimal diagnostic threshold,sensitivity and specificity of ADC value and SUV value were calculated,analyzing the diagnostic efficacy of SUV value and ADC value on benign and malignant bone lesions.RESULTS(1)Retrospective cohort analysis was performed on 325 patients with suspected malignant bone lesions who received both 18F-FDG PET/CT and pathological examination from December 2010 to May 2018.Among them,300 patients were pathologically diagnosed as malignant tumors,and the diagnosis of 264 cases was consistent with 18F-FDG PET/CT.The PPV of 18F-FDG PET/CT for bone malignant tumors was 92.31%(95%CI:88.84-94.76%),and the coincidence rate of 18F-FDG PET/CT diagnosis and pathological diagnosis for bone malignant tumors was 81.23%(95%CI:76.59-85.13%).102 patients with suspected primary bone tumors had PPV of 97.06%(95%CI:91.12-99.07%),and the coincidence rate was 85.29%(95%CI:76.86-91.01%).223 patients with suspected bone metastasis had PPV of 90.13%(95%CI:76.86-91.01%),and the coincidence rate was 79.37%(95%CI:73.51-84.22%).Bone lesions with a standard uptake value of 5 or more are more likely to be malignant(p=0.005).(2)150 patients in the PET group and 150 patients in the CT group were enrolled between December 2016 and January 2019.There were significant differences in the number of puncture sites and bone lesions between the two groups(p=0.022 p=0.002),and the number of bone lesions in the PET group was more common in the spine than CT group.In PET group,11 cases had benign lesions,131 cases had malignant lesions,and 8 cases had no definite diagnosis,the diagnostic rate of bone malignant lesions was 87.4%.In the CT group,21 cases had benign lesions,112 cases had malignant lesions,and 17 cases had not been clearly diagnosed,the diagnostic rate of bone malignant lesions was 74.7%(p=0.02).(3)32 patients in PET group received WB-DWI imaging examination.The ADC value of malignant lesions at the puncture site was(1.13±0.43)×10-3mm2/s,and the corresponding SUV value was 9.85±4.68.The ADC value of benign lesions was(1.93±0.17)×10-3mm2/s,and the corresponding SUV value was 3.36±0.82.Pearson correlation coefficient between SUV value and ADC value was-0.882(|r|=0.882,significance level is below 0.01),showing a significant correlation,the area under the ROC curve(AUC)was 0.926 and 0.941 respectively.When the ADC value was 1.38×10-3mm2/s,the sensitivity and specificity of the differential diagnosis was 100.00%and 81.48%,respectively.When the standard uptake value was 4.4,the sensitivity and specificity of differential diagnosis was 100.00%and 88.89%,respectively.CONCLUSIONS(1)18F-FDG PET/CT is an effective tool for the diagnosis of suspicious bone lesions.However,the PPV and coincidence rate of 18F-FDG PET/CT are not enough to replace the traditional bone pathology technology to detect bone malignancies with 18F-FDG PET/CT,which has been proved to be an effective method by pathology.(2)In the clinical high-risk population of primary or metastatic bone malignant tumors,the use of 18F-FDG PET/CT images to select puncture points can effectively improve the diagnostic rate of CT-guided bone biopsy for malignant tumors.(3)SUV value and ADC value are significantly correlated in the diagnosis of bone lesions.The use of these two indicators to detect bone malignant tumors can promote the early diagnosis and treatment of patients,improve the prognosis and improve the survival rate. |
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