CAJ | 학술논문

目的：探讨骨肉瘤18F-FDG PET/CT显像的影像学特征，及其对评价骨肉瘤患者预后的价值。资料与方法回顾性分析经病理证实的30例原发性骨肉瘤患者的同机PET/CT影像学特点，获得肿瘤病灶最大标准化摄取值（SUVmax）和CT值，计算肿瘤体积；根据有无肿瘤复发、转移或死亡计算无病生存时间；比较CT表现为不同组织成分的SUVmax，分析各部位SUVmax与对应CT值的相关性及影响预后的因素。结果28例CT表现为骨质破坏、20例斑片样或棉絮样低密度瘤骨、24例软组织肿块及16例骨膜反应均表现为18F-FDG摄取增高，17例象牙质等高密度瘤骨呈低摄取。高密度瘤骨SUVmax低于骨质破坏、低密度瘤骨、软组织肿块SUVmax（F=5.196，P<0.01）。骨质破坏、低密度瘤骨、高密度瘤骨、软组织肿块SUVmax与对应的CT值呈负相关（r=－0.315，P<0.01)。30例患者平均无瘤生存时间为（36.9±14.9）个月。Kaplan-Meier曲线分析显示，SUVmax≥9患者的无病生存时间较SUVmax<9患者长（χ2=0.696，P<0.05）。Cox回归分析显示SUVmax是影响预后的独立因素（Wald=4.213，P<0.05）。结论18F-FDG PET/CT实现了对原发性骨肉瘤解剖结构改变和代谢变化的优势互补，结合半定量分析有助于找到复杂结构肿瘤中生物活性最高的部分，低密度/高代谢瘤骨提示高度恶性；骨肉瘤原发病灶的SUVmax越高，患者预后越差。
목적：탐토골육류18F-FDG PET/CT현상적영상학특정，급기대평개골육류환자예후적개치。자료여방법회고성분석경병리증실적30례원발성골육류환자적동궤PET/CT영상학특점，획득종류병조최대표준화섭취치（SUVmax）화CT치，계산종류체적；근거유무종류복발、전이혹사망계산무병생존시간；비교CT표현위불동조직성분적SUVmax，분석각부위SUVmax여대응CT치적상관성급영향예후적인소。결과28례CT표현위골질파배、20례반편양혹면서양저밀도류골、24례연조직종괴급16례골막반응균표현위18F-FDG섭취증고，17례상아질등고밀도류골정저섭취。고밀도류골SUVmax저우골질파배、저밀도류골、연조직종괴SUVmax（F=5.196，P<0.01）。골질파배、저밀도류골、고밀도류골、연조직종괴SUVmax여대응적CT치정부상관（r=－0.315，P<0.01)。30례환자평균무류생존시간위（36.9±14.9）개월。Kaplan-Meier곡선분석현시，SUVmax≥9환자적무병생존시간교SUVmax<9환자장（χ2=0.696，P<0.05）。Cox회귀분석현시SUVmax시영향예후적독립인소（Wald=4.213，P<0.05）。결론18F-FDG PET/CT실현료대원발성골육류해부결구개변화대사변화적우세호보，결합반정량분석유조우조도복잡결구종류중생물활성최고적부분，저밀도/고대사류골제시고도악성；골육류원발병조적SUVmax월고，환자예후월차。
PurposeTo discuss the imaging characteristics and prognostic value of 18F-FDG PET/CT in primary osteosarcoma.Materials and MethodsThirty patients with osteosarcoma confirmed by pathology were enrolled in the study. The imaging characteristics of preoperative whole body18F-FDG PET/CT were analyzed retrospectively. The max standard uptake values (SUVmax) and CT values of lesions were obtained, and tumor volume was calculated; disease-free survival duration was calculated according to the reoccurrence and metastasis of tumor and death; the SUVmax of different components was compared, and the SUVmax in each position was analyzed in terms of the correlation with the corresponding CT value and factors influencing the prognosis.ResultsCT images showed that 28 patients with primary osteosarcoma had bone destruction, 20 had ground-glass or cotton-like neoplastic bone, 24 with soft tissue mass and 16 with periosteal reaction had increased18F-FDG uptake, and 17 with high-density neopalstic bone had low 18F-FDG uptake. The SUVmax of high-density neoplastic bone was significantly lower than that of bone destruction, low-density neoplastic bone and soft tissue mass (F=5.196, P<0.01). There was a weak negative correlation between the SUVmax of various parts such as bone destruction, low-density neoplastic bone, high-density neoplastic bone and soft tissue mass and the corresponding CT value (r=-0.315,P<0.01). The disease free survival time was (36.9±14.9) months. The Kaplan-Meier curve analysis showed that the disease free survival time was longer in patients with SUVmax≥9 than in those with SUVmax<9 (χ2=0.696,P<0.05). The Cox regression analysis presented that SUVmax had independent prognostic value (Wald=4.213,P<0.05).Conclusion18F-FDG PET/CT has advantages in presenting the anatomical structure changes and metabolic changes in primary osteosarcoma. Combined with semi-quantitative analysis of SUVmax, PET/CT can be helpful in finding out the highest biological activity part from the complex tumor structures. Neoplastic bone with low density/high metabolism suggests high malignancy. The higher the SUVmax, the worse the prognosis is in patients with primary osteosarcoma.