SO SÁNH GIỮA CHỤP XẠ HÌNH XƯƠNG VÀ CHỤP CẮT LỚP VI TÍNH TRONG PHÁT HIỆN DI CĂN XƯƠNG Ở BỆNH NHÂN UNG THƯ BIỂU MÔ TẾ BÀO GAN

Abstract

Aim: To compare the diagnostic accuracy of bone scintigraphy (BS) and computed tomography (CT) in detecting skeletal metastases for hepatocellular carcinoma (HCC) patients with suspicious bone metastasis. Methods: A prospective study was carried out in 57 HCC patients. The accuracies of BS and CT were determined by comparing with final diagnosis with criteria obvious progression of the lesion revealed from the follow-up examinations and treatment. Results: This study included 48 male and 9 female, mean age 60.5 ± 12.9. Reasons for bone scintigraphy: Tumor extent surveillance: 54.4%, bone pain: 29.8%, limb weakness: 14%, palpable chest wall mass: 1.8%. There was a significant difference in bone metastatic detection between BS (45.6%) and CT (29.8%), p=0.001. There were 23 metastatic regions on CT, tended to identify more positive lesions in the spine: 14/23, pelvis: 5/23; 45 regions in BS, tended to show more positive lesions in the spine: 19/45, ribs: 12/45. According to the follow-up result and palliative treatment by SBRT, for detecting metastatic bone lesions by CT: Sensitivity = 72.2%, Specificity = 89.7%, Positive Predictive Value = 76.5%, Negative Predictive Value = 87.5%, Accuracy = 84.2%; by BS: Sensitivity = 100%, Specificity = 79.5%, Positive Predictive Value = 69.2%, Negative Predictive Value = 100%, Accuracy = 86.0%. Conclusion: BS has significantly better accuracy than CT in detecting metastatic HCC bone lesions, but  to determine bone metastases, careful history taking, meticulous physical examination and perfoming many bone scan methods are very important.