摘要
目的全身骨显像可清晰显示全身骨骼形态及代谢情况,检出骨骼疾病。本研究分析全身骨显像质量影响因素及其相关性,并提出改进措施。方法选取2018-04-01-2018-08-30在山东省肿瘤医院核医学科行99Tcm-亚甲基二膦酸盐(99Tcm-Methylenediphosphonate,99Tcm-MDP)全身骨显像的患者1 524例,显像质量根据单光子发射计算机断层扫描/计算机断层扫描(single photon emission computed tomography/computed tomography,SPECT/CT)仪临床使用评价指标分为质量佳(A)、质量良好(B)、质量差(C)3组,总结性别、年龄、血钙、尿素氮、肌酐、体质量指数(body mass index,BMI)、注射至显像间隔时间、注射部位核素有无浓集、治疗措施、膀胱充盈状态、软组织摄取状态、携带异物及核素污染等资料,计量资料对显像质量有影响者进一步分组并进行组间比较;采用χ2检验及多分类Logistic回归分析进行回顾性研究,分析全身骨扫描显像质量的相关影响因素并提出改进方法。结果本研究中显像质量佳者(A)约占40.0%(610/1 524),显像质量良好者(B)约占50.3%(766/1 524),显像质量差者(C)约占9.7%(148/1 524);全身骨扫描图像质量与性别(χ2=73.143,P<0.001)、年龄(χ2=11.543,P=0.003)、BMI(χ2=16.057,P=0.000)、注射至显像间隔时间(χ2=20.226,P<0.001)、注射部位核素异常浓集(χ2=10.880,P=0.004)、放疗(χ2=20.871,P<0.001)、膀胱充盈(χ2=75.929,P<0.001)及软组织摄取(χ2=338.872,P=0.001)均有统计学意义的关联;与患者血钙、尿素氮、肌酐、携带异物及核素污染无统计学意义的关联。居于首位的影响因素为注射点核素浓集,约占10.8%(164/1 524),其次为软组织摄取高及膀胱充盈,分别占7.4%(113/1 524)和6.6%(101/1 524);对年龄及BMI进行组间比较发现,显像质量佳(A)及质量良好者(B)年龄<45岁组与45~59岁组及≥60岁组<24.0kg/m2分别与24.0~27.0kg/m2及BMI>27.0kg/m2组间差异有统计学意义,45~59岁与≥60岁组、24.0~27.0kg/m2与>27.0kg/m2组间差异无统计学意义;显像质量差者(C)BMI<24.0kg/m2组和24.0~27.0kg/m2组间差异有统计学意义,年龄组间差异无统计学意义。结论在临床工作中影响全身骨扫描图像质量的因素较多,主要有性别、年龄、BMI、注射部位核素浓集、软组织摄取、膀胱充盈状态、注射至显像间隔时间等;人为可控因素中,提高注射技术、降低软组织摄取及检查前及时排空膀胱等方法可明显提高显像质量。
OBJECTIVE Whole-body bone scan is the most common examination in nuclear medicine.It can clearly show the bone morphology and reflect bone metabolism,which is very helpful for detecting bone diseases.This paper aimed to analyze the influencing factors and relevance of the quality of whole-body bone imaging,and propose improvement measures to improve image quality.METHODS A retrospective study was selected on 1 524 patients who received wholebody bone scan in nuclear medicine department from Apr 1 2018 to Aug 30 2018 in Shan Dong Tumor Hospital;The image quality was classified into good quality(group A),general quality(group B)and poor quality(group C)according to the clinical evaluation index of SPECT/CT instrument;summarizing gender,age,blood calcium,urea nitrogen,creatinine,body mass index(BMI),injection to imaging interval,nuclide concentration at the injection site,treatment measures,bladder filling status,soft tissue intake,foreign bodies and nuclide contamination,etc;measurement data that has influence on image quality is further grouped and compared between groups;Chi-Square Test(χ~2 test)and Multinomial Logistic were used to analyze influencing factors and relevance for quality of whole-body bone scan imaging and topropose improvement methods.RESULTS In this study,40.0%(610/1 524)patients had good quality(group A),50.3%(766/1 524)patients with general quality(group B)and 9.7%(148/1 524)patients with poor quality(group C).The quality of the wholebody bone scan was correlated with gender(χ~2=73.143,P<0.001),age(χ~2=11.543,P=0.003),BMI(χ~2=16.057,P=0.000),injection to imaging interval(χ~2=20.226,P<0.001),nuclide abnormal concentration at the injection site(χ~2=10.880,P=0.004),radiotherapy(χ~2=20.871,P<0.001),bladder filling state(χ~2=75.929,P<0.001)and soft tissue uptake(χ~2=338.872,P<0.001).Blood calcium,urea nitrogen,creatinine,foreign body and nuclide contamination were not statistical relevance with image quality.The first influencing factor was injection technique,accounting for 10.8%(164/1 524),followed by high soft tissue intake and bladder filling,accounting for 7.4%(113/1 524)and 6.6%(101/1 524).Comparison age and BMI showed that there were statistical differences between ages<45 years and the other two groups(ages 45-59 years and≥60 years),BMI≤24.0 kg/m2 and the other two groups(BMI 24.0-27.0 kg/m2 and BMI>27.0 kg/m2)in the good quality and general quality group(A and B);and no significant difference between the ages 45-59 years and≥60 years,BMI 24.0-27.0 kg/m2 and>27.0 kg/m2.there were statistical differences between the BMI<24.0 and 24.0-27.0 in the group C,and no significant difference between the age groups.CONCLUSIONS There are many factors affecting the quality of whole-body bone scan images in clinical work;the main factors are gender,age,BMI,nuclide concentration at the injection site,soft tissue intake,bladder filling state,injection to imaging interval.Among artificially controllable factors,improving injection techniques,reducing soft tissue intake and emptying the bladder before examination can significantly improve the quality of imaging.
作者
卢婷婷
王晓慧
霍宗伟
孔琪
杨国仁
LU Ting-ting;WANG Xiao-hui;HUO Zong-wei;KONG Qi;YANG Guo-ren(School of Medicine and Life Science,University of Jinan-Shandong Academy of Medical Science,Jinan 250200,P.R.China;Department of Nuclear Medicine,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2020年第5期386-392,397,共8页
Chinese Journal of Cancer Prevention and Treatment
基金
山东省自然科学基金(2R2016HM62)。
