The Clinical Value Of Multimodal Imaging Technology In The Diagnosis Of Prostate Cancer Bone Metastasis

Purpose:（1）To discuss whether the occurrence of prostate cancer bone metastasis is correlated with age and Gleason scoring.（2）Prostate cancer patients were scanned by ^99mTc-MDP systemic imaging and local SPECT/CT tomography to definitely diagnose whether the bone metastasis exists in prostate cancer patients,and whether the distribution characteristics of prostate cancer bone metastasis foci statistical difference has statistic difference.（3）By comparing CT,MRI and 99m Tc-MDP systemic bone imaging+local SPECT/CT tomography,the three examination methods on the diagnostic efficacy of prostate cancer bone metastas was analyzed and evaluated,and the clinical guide signifycance of^99mTc-MDP systemic bone imaging+local SPECT/CT tomography in the prostate cancer bone metastasis was researched.Methods:Total 77 patients with prostate cancer confirmed by pathology in Baoji Central Hospital from January 2017 to June 2018 was conducted retrospective analysis,the patients’related clinical and image data was collected and analyzed statistically,combined with the age and the Gleason scoring of prostate cancer of the patients,the correlation between age and the Gleason scoring of prostate cancer with the bone metastasis occurrence was discussed.^99mTc-MDP systemic bone imaging(^99mTc–MDP systemic bone imaging of total 115patients was undergone at different time period)was undergone in 77 patients,among them,SPECT/CT tomosynthesis was additionally undergone in 32 patients;Pelvic MRI in 69patients and CT pelvic imaging examination in 13 were performed.The number of bone metastasis patients and the distribution characteristics of bone metastasis were definitely diagnosed;CT,MRI and systemic bone imaging and local SPECT/CT tomosynthesis were respectively analyzed,and various imaging diagnosis were clarified,all kinds of examination sensitivity、specificity、positive predictive value、Negative predi-ctivevalue、accuracy were calculated.Secondly,13 prostate cancer patients who finished the two homochronous exami-nations of CT and systemic bone imaging+local SPECT/CT tomosynthesis were selected;69 prostate cancer patients who finished the two homochronous examinations of MRI and systemic bone imaging and local SPECT/CT tomosynthesis analyzed various diagnostic methods to diagnose the accuracy difference of prostate cancer bone metastasis by pairing Chi-square test and the consistency degree of prostate cancer bone metastasis diagnosis by various imaging methods.Results:1.With 1 case of abnormal nuclide concentration foci aged 50 to 59,11 cases of abnormal nuclide concentration foci aged 60 and 69,25 cases of abnormal nuclide concen-tration foci aged 70 and 79,and 8 cases of abnormal nuclide concentration foci aged above80,without statistical difference in distribution among different ages（F=0.266,P=0.850）.2.Gleason scoring:therein,No.8 metastatic tumor incidence of scoring 10 patients was 75.00%,50.00%for scoring 9,56.25%for scoring 8,40.00%for scoring 7,25.00%for scoring 6,and 25.00%for scoring 5,and the difference among the scoring groups was statistically significant（P=0.008）,and the occurrence of metastatic tumor was correlated with Gleason scoring（r=0.928）.3.In 77 cases of prostate cancer patients,38 patients were diagnosed as prostate cancer bone metastasis,when the prostate cancer bone metastasis occurs,the spine is most common for its metastasis foci（cervical vertebra,thoracic vertebra and lumbar vertebra）,followed by the pelvis,sternum and rib,while the limbs（the shoulder blade and clavicle included）is relatively rare,least metastatic in the skull,and there was statistical significance for difference among groups（F=8.103,P=0.000）.4.The data of prostate cancer bone metastasis was diagnosed by conducting systemic bone scan and SPECT/CT local viscera tomography in 77cases:sensitivity:100%,specificity:84.6%,positive predictive value:86.4%,negative predictive value:100%,The data of MRI in the diagnosis of prostate cancer bone metastasis was as follows sensitivity:100%,specificity:84.6%,correct exponent:85.0%,positive predictive value:86.4%,negative predictive value:100%,false positive rate:15.4%,false negative rate0%,misdiagnosis:15.4%,missed diagnosis rate:0%,diagnose accordance rate:92.2%（χ²=0.939,P=0.333）.The data of prostate cancer bone metastasis was diagnosed by conducting MRI imaging in 69 cases:sensitivity:97.1%,specificity:100%,correct exponent:97.1%,positive predictive value:100%,negative predictive value:97.1%,misdiagnosis:0%,missed diagnosis rate:2.9%,false positive rate 0%,false negative rate 2.9%,diagnose accordance rate 98.6%.The prostate cancer bone metastasis was diagnosed by conducting CT ray imaging in 13 cases,sensitivity 83.3%,specificity:100%,correct exponent:83.3%,positive predictive value:100%,negative predictive value:87.5%,misdiagnosis:0%,missed diagnosis rate:17%,false positive rate:0%,false negative rate:17%,diagnose accordance rate:92.3%.69 prostate cancer patients finished the two homochronous examinations of systemic bone scan+SPECT/CT viscera tomosynthesis and pelvic MRI,therein,the data of systemic bone scan and SPECT/CT viscera tomosynthesis in the diagnosis of prostate cancer bone metastasis was as follows:diagnose accordance rate:85.2%,sensitivity:100%,specificity:85.2%,positive predictive value:87.5%,negative predictive value:100%,The data of MRI in the diagnosis of prostate cancer bone metastasis was as follows accordance rate:97.1%,sensitivity:97.1%,specificity:100%,positive predictive value:100%,negative predictive value:97.1%.13 prostate cancer patients finished the two homochronous examinations of systemic bone scan+SPECT/CT viscera tomosynthesis and pelvic CT,therein,systemic bone scan+SPECT/CT viscera tomosynthesis in the diagnosis of prostate cancer bone SPECT/CT compared with the definite diagnosis cases,the diagnosis coincidence rate was as follows:diagnose accordance rate:100%,sensitivity:100%,specificity:100%,positive predictive value:100%,negative predictivevalue:100%,correct exponent 100%,false positive rate:0%,false negative rate:0%,misdiagnosis:0%,missed diagnosis rate 0%.compared with the definite diagnosis cases,the diagnosis coincidence rate of CT was as follows:diagnose accordance rate:92%,sensitivity:83.3%,specificity:100%,positive predictive value:100%,negative predictivevalue:87.5%,correct exponent:0.833,false positive rate:0%,false negative rate:16%,misdiagnosis:0%,missed diagnosis rate:16%.Without significant difference in the accuracy of systemic bone scan+local SPECT/CT fusion imaging and MRI imaging in the diagnosis of prostate cancer bone metastasis（χ²=0.029,P=0.865）.Without statistics difference in the accuracy of systemic bone scan and local SPECT/CT viscera tomosynthesis and CT examination in the diagnosis of prostate cancer bone metastasis（χ²=0.158,P=0.691）.The SPECT and MRI two examinations were respectively conducted consistency test with the re-examination definite diagnosis cases with respective Kappa（0.855,0.971）,and the SPECT and MRI was conducted consistency test with respective Kappa（0.826）.Systemic bone scan+local SPECT/CT viscera tomosynthesis and CT imaging diagnosis of the prostate cancer bone metastasis,two methods of examination were respectively conducted consistency test with the re-examination definite diagnosis cases with the respective Kappa 1,0.843.SPECT and CT two examinations were conducted consistency test with the Kappa 0.843.Conclusions:1.Without statistical difference in the distribution of prostate cancer bone metastasis occurrence in different ages.2.Gleason scoring was positively correlated with the prostate cancer bone metastasis occurrence.The higher Gleason scoring,the higher the incidence of prostate cancer bone metastasis.3.Prostate cancer is incident to the bone metastasis,and the spine is most common for its metastasis foci（cervical vertebra,thoracic vertebra and lumbar vertebra）,followed by the pelvis,sternum and rib,while the limbs（the shoulder blade and clavicle included）is relatively rare,least metastatic in the skull.4.Respectively compared with CT,MRI and re-examination definite diagnosis cases,^99mTc-MDP systemic bone imaging+local SPECT/CT tomography had high consistency in the diagnosis of prostate cancer bone metastases,in comparison of three methods of examination,^99mTc-MDP systemic bone imaging+local SPECT/CT tomography had high sensitivity for the diagnosis of prostate bone metastases,while MRI diagnosis of prostate cancer bone metastases had high specificity,and bone imaging and MRI two examinations can achieve complementary advantages,improve the diagnostic efficiency of prostate cancer bone metastases,however,bone imaging is superior to MRI in wide scanning range,short-time examination,and understanding the patient’s systemic bone conditions only by initial examination etc.,which has better clinical application value for the diagnosis of prostate cancer bone metastasis.