中华核医学与分子影像杂志
中華覈醫學與分子影像雜誌
중화핵의학여분자영상잡지
Chinese Journal of Nuclear Medicine and Molecular Imaging
2014年
2期
100-102
,共3页
叶雪梅%张春燕%章晨%陈天亮%龙斌
葉雪梅%張春燕%章晨%陳天亮%龍斌
협설매%장춘연%장신%진천량%룡빈
甲状腺肿瘤%放射性核素显像%碘放射性同位素%诊断,鉴别
甲狀腺腫瘤%放射性覈素顯像%碘放射性同位素%診斷,鑒彆
갑상선종류%방사성핵소현상%전방사성동위소%진단,감별
Thyroid neoplasms%Radionuclide imaging%Iodine radioisotopes%Diagnosis,differential
目的 评价131I SPECT/CT显像在DTC患者中相对于131I全身显像(WBS)的增益价值.方法 回顾性对比分析97例DTC患者[男31例,女66例,平均年龄44.1(17～74)岁]176个摄碘灶的131I WBS和131I SPECT/CT显像资料.显像均为131I治疗后的常规扫描,SPECT/CT显像针对WBS发现的病灶进行.由2位核医学科医师阅片,以病理及随访结果为诊断标准,分析131I SPECT/CT及131I WBS对摄碘灶定位定性的诊断能力,并应用SPSS 13.0对两者诊断准确性进行x2检验.结果 131I WBS检出摄碘灶175个(颈部128个,远处灶47个),SPECT/CT检出病灶176个(颈部128个,远处灶48个).173个病灶经病理及随访确诊,良性78个,恶性95个;3个未定性(仍在随访中).确诊的摄碘灶中,残留甲状腺组织51个,颈部淋巴结转移或局部残留病灶67个,生理性摄取灶7个,远处转移灶30个,远处生理性摄取灶18个.131I WBS诊断摄碘灶的灵敏度73.7％(70/95),特异性78.2％(61/78),准确性61.3％ (106/173);其准确性低于131I SPECT/CT(98.8％,171/173;x2=72.3,P＜0.05).131I SPECT/CT纠正131I WBS误判摄碘灶67个,其中纠正定位错误27个,定性错误40个;颈部37个[占全部颈部灶的28.9％ (37/128)],远处灶30个(62.5％,30/48).与131I WBS的最初诊断相比,131I SPECT/CT显像改变了27个转移部位的诊断,改变了8例患者临床分期的诊断,并最终改变了14例患者的治疗方案.结论 131I SPECT/CT可以弥补131I WBS的不足,更准确区分残余甲状腺组织和淋巴结、肺或骨等远处转移及生理性摄取,对于DTC的诊治有较好的增益价值.
目的 評價131I SPECT/CT顯像在DTC患者中相對于131I全身顯像(WBS)的增益價值.方法 迴顧性對比分析97例DTC患者[男31例,女66例,平均年齡44.1(17～74)歲]176箇攝碘竈的131I WBS和131I SPECT/CT顯像資料.顯像均為131I治療後的常規掃描,SPECT/CT顯像針對WBS髮現的病竈進行.由2位覈醫學科醫師閱片,以病理及隨訪結果為診斷標準,分析131I SPECT/CT及131I WBS對攝碘竈定位定性的診斷能力,併應用SPSS 13.0對兩者診斷準確性進行x2檢驗.結果 131I WBS檢齣攝碘竈175箇(頸部128箇,遠處竈47箇),SPECT/CT檢齣病竈176箇(頸部128箇,遠處竈48箇).173箇病竈經病理及隨訪確診,良性78箇,噁性95箇;3箇未定性(仍在隨訪中).確診的攝碘竈中,殘留甲狀腺組織51箇,頸部淋巴結轉移或跼部殘留病竈67箇,生理性攝取竈7箇,遠處轉移竈30箇,遠處生理性攝取竈18箇.131I WBS診斷攝碘竈的靈敏度73.7％(70/95),特異性78.2％(61/78),準確性61.3％ (106/173);其準確性低于131I SPECT/CT(98.8％,171/173;x2=72.3,P＜0.05).131I SPECT/CT糾正131I WBS誤判攝碘竈67箇,其中糾正定位錯誤27箇,定性錯誤40箇;頸部37箇[佔全部頸部竈的28.9％ (37/128)],遠處竈30箇(62.5％,30/48).與131I WBS的最初診斷相比,131I SPECT/CT顯像改變瞭27箇轉移部位的診斷,改變瞭8例患者臨床分期的診斷,併最終改變瞭14例患者的治療方案.結論 131I SPECT/CT可以瀰補131I WBS的不足,更準確區分殘餘甲狀腺組織和淋巴結、肺或骨等遠處轉移及生理性攝取,對于DTC的診治有較好的增益價值.
목적 평개131I SPECT/CT현상재DTC환자중상대우131I전신현상(WBS)적증익개치.방법 회고성대비분석97례DTC환자[남31례,녀66례,평균년령44.1(17～74)세]176개섭전조적131I WBS화131I SPECT/CT현상자료.현상균위131I치료후적상규소묘,SPECT/CT현상침대WBS발현적병조진행.유2위핵의학과의사열편,이병리급수방결과위진단표준,분석131I SPECT/CT급131I WBS대섭전조정위정성적진단능력,병응용SPSS 13.0대량자진단준학성진행x2검험.결과 131I WBS검출섭전조175개(경부128개,원처조47개),SPECT/CT검출병조176개(경부128개,원처조48개).173개병조경병리급수방학진,량성78개,악성95개;3개미정성(잉재수방중).학진적섭전조중,잔류갑상선조직51개,경부림파결전이혹국부잔류병조67개,생이성섭취조7개,원처전이조30개,원처생이성섭취조18개.131I WBS진단섭전조적령민도73.7％(70/95),특이성78.2％(61/78),준학성61.3％ (106/173);기준학성저우131I SPECT/CT(98.8％,171/173;x2=72.3,P＜0.05).131I SPECT/CT규정131I WBS오판섭전조67개,기중규정정위착오27개,정성착오40개;경부37개[점전부경부조적28.9％ (37/128)],원처조30개(62.5％,30/48).여131I WBS적최초진단상비,131I SPECT/CT현상개변료27개전이부위적진단,개변료8례환자림상분기적진단,병최종개변료14례환자적치료방안.결론 131I SPECT/CT가이미보131I WBS적불족,경준학구분잔여갑상선조직화림파결、폐혹골등원처전이급생이성섭취,대우DTC적진치유교호적증익개치.
Objective To evaluate the incremental value of 131I SPECT/CT over 131I whole body scan (WBS) in the patients with DTC.Methods A total of 97 patients with DTC (31 males,66 females,mean age:44.1 years,age range:17 to 74 years) were retrospectively reviewed.All subjects underwent 131I WBS and SPECT/CT after 131I treatment.The images were interpreted by 2 experienced nuclear medicine physicians.The final diagnosis was based on the pathologic findings and clinical follow-up.The diagnostic accuracies between 131I WBS and 131I SPECT/CT were compared using x2 test with SPSS 13.0.Results 131I WBS detected 175 lesions (128 neck and 47 distant lesions),while 131I SPECT/CT found 176 lesions (128 neck and 48 distant lesions).Out of the 176 lesions,78 were confirmed as benign and 95 as malignant,including 51 lesions in thyroid bed,67 cervical lymph nodes or local residual lesions,7 lesions related to local physiological uptake,30 distant metastases and 18 distant foci due to physiological uptake.The other 3 lesions were still in follow-up.The sensitivity and specificity of 131 I WBS was 73.7％ (70/95) and 78.2％ (61/78),respectively.The accuracy of 131I WBS (106/173,61.3％) was lower than that of 131I SPECT/CT (171/173,98.8％; x2=72.3,P＜0.05).131I SPECT/CT corrected the diagnosis of 131I WBS in 67 lesions,including 37 local lesions (37/128,28.9％) and 30 (30/48,62.5％) distant metastases.The sources of error for the 67 lesions were due to wrong location (n =27) or wrong characterization (n =40).Compared with 131I WBS,131I SPECT/CT changed the location in 27 lesions,clinical staging in 8 cases and therapeutic strategy in 14 cases.Conclusions 131 I SPECT/CT could improve the differentiation of malignant local lesions from residual thyroid,of distant metastatic lymph node,lung or bone lesions from physiological uptake.Such incremental values would be valuable to the management of DTC patients compared with WBS.
