前列腺癌骨转移18F-FDG PET/CT表现与临床资料的相关分析

摘要

目的:分析治疗前前列腺癌骨转移18F-FDG PET/CT表现特点,并探讨其与肿瘤分化程度及前列腺特异性抗原(prostate specific antigen,PSA)的相关性.方法:回顾性分析25例确诊前列腺癌骨转移病例的骨转移瘤的分布、数目、密度及FDG摄取特点,进一步分析PSA水平及肿瘤分化程度与骨转移灶的FDG摄取程度、骨转移类型及骨转移灶累及范围的相关性.结果:25例中有低分化癌8例,中分化癌17例,无高分化癌病例;所有患者PSA均大于10 μg/ml,其中PSA≥20 μg/ml者19例,低于20 μg/ml者6例.25例骨转移中局限于骨盆及下腰椎者8例,余17例均为骨多发或弥漫性累及.Fisher确切概率法显示,低分化癌较中分化癌更易于发生非成骨性骨转移(P=-0.022),骨转移类型与PSA升高程度无关.各组骨转移累及范围的差异无统计学意义.结论:前列腺癌骨转移多见于PSA明显升高及分化较差的患者,18F-FDG PET/CT是早期发现前列腺癌骨转移较好的影像学方法.肿瘤分化程度不同18F-FDG PET/CT表现不同,低分化癌更多表现为非成骨性骨转移且FDG摄取程度较高,而中分化癌更多表现为成骨性骨转移,FDG摄取程度相对较低.前列腺癌骨转移灶的PET/CT表现与PSA水平无相关性.%Objective To analyze the relationship between 18F-FDG PET/CT manifestations,tumor differentiation and PSA for the patients with bone metastases from prostate cancer.Methods Retrospective analysis was executed on the distribution,number and density of bone metastases tumor and FDG uptake as well as the relationship between serum PSA,FDG uptake of bone metastases focus,type of bone metastases and the involved range.Results Of the 25 cases,there were 8 ones of poorly differentiated carcinoma and 17 ones of moderately differentiated carcinoma.All the patients had serum PSA higher than 10 μg/ml,of whom there were 19 ones had the PSA not lower than 20 μg/ml.Eight patients with bone metastases restrained in the pelvis and lower lumbar vertebra,and the remained 17 ones had multiple or diffuse bone metastases.Fisher's exact test showed that non-osteoblastic metastases were more common in low-and medium-differentiation patients (P=0.022),the typing of bone metastases had no relationship with the enhancement of PSA,and there were no statistical differences between the involved ranges of the patients.Conclusion Bone metastases from prostate cancer often occurs in the patient with obviously enhanced PSA and poorly differentiation.18F-FDG PET/CT behaves well in the early diagnosis of bone metastases from prostate cancer.18F-FDG PET/CT manifestations differ with the differentiation of carcinoma,poorly differentiated carcinoma shows non-osteoblastic metastases and high FDG uptake,and moderately differentiated carcinoma appears as osteoblastic metastases and low FDG uptake.There is no confirmed correlation between PET/CT manifestation and total serum PSA for the patients with bone metastases from prostate cancer.