国际放射医学核医学杂志
國際放射醫學覈醫學雜誌
국제방사의학핵의학잡지
INTERNATIONAL JOURNAL OF RADIATION MEDICINE AND NUCLEAR MEDICINE
2014年
6期
392-397
,共6页
王深%孟召伟%贾强%张富海%谭建
王深%孟召偉%賈彊%張富海%譚建
왕심%맹소위%가강%장부해%담건
格雷夫斯病%甲状腺炎%磁共振成像,弥散%表观弥散系数%甲状腺摄131I率%促甲状腺激素受体抗体
格雷伕斯病%甲狀腺炎%磁共振成像,瀰散%錶觀瀰散繫數%甲狀腺攝131I率%促甲狀腺激素受體抗體
격뢰부사병%갑상선염%자공진성상,미산%표관미산계수%갑상선섭131I솔%촉갑상선격소수체항체
Graves disease%Thyroiditis%Diffusion magnetic resonance imaging%Apparent diffusion coefficient%Thyroid radioactive iodine uptake%Thyrotropin receptor antibody
目的 研究MRI弥散加权成像(DWI)的表观弥散系数(ADC)、甲状腺摄131I率(RAIU)和血清指标等在Graves甲状腺功能亢进症(简称甲亢)和无痛性甲状腺炎(PT)鉴别中的价值.方法 选取102例Graves甲亢患者和37例PT患者入组.测定所有患者的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、TSH、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)和促甲状腺激素受体抗体(TRAb)水平.采用3.0T超导型MRI仪完成MRI检查,并获得ADC.测定甲状腺24 h RAIU,并进行甲状腺静态显像.Graves甲亢患者的病理组织从接受手术的患者中获取(6例),PT患者的病理组织从接受活检的患者中获取(2例).采用Pearson检验明确各指标间的相关性,用受试者工作特征曲线(ROC)分析各项指标的诊断价值,确定各项指标的切分点值,并判断各项指标的诊断灵敏度、特异度、准确率、阳性预测值和阴性预测值.结果 与PT患者比较,Graves甲亢患者的ADC、TRAb和RAIU显著升高(t=15.126、7.226和31.574,P均＜0.01).ADC、TRAb和RAIU之间存在显著的正相关性.ROC显示,RAIU、ADC和TRAb的曲线下面积大于0.900.其中,RAIU具有最好的诊断价值,当最佳切分点值确定为24.500％时,灵敏度、特异度、准确率、阳性预测值和阴性预测值均为100％.ADC比TRAb的诊断价值更高,当最佳切分点值分别确定为1.837×10-3 mm2/s和1.350 IU/ml时,ADC的上述统计指标分别为96.078％、91.892％、95.000％、97.059％和89.474％,TRAb的上述统计指标分别为88.235％、75.676％、84.892％、90.909％和70.000％.病理组织学结果显示:Graves甲亢以滤泡增生、滤泡上皮细胞增生以及血管扩张和充血为主要表现;PT以淋巴细胞浸润、淋巴滤泡形成以及滤泡破坏为主要表现.结论 对于Graves甲亢和PT的鉴别,RAIU、ADC和TRAb均有价值,RAIU最佳、ADC次之.ADC的显像原理是基于不同疾病细胞密度差异的病生理变化,而RAIU的测定原理是反映不同疾病对碘摄取能力差异的病生理变化.
目的 研究MRI瀰散加權成像(DWI)的錶觀瀰散繫數(ADC)、甲狀腺攝131I率(RAIU)和血清指標等在Graves甲狀腺功能亢進癥(簡稱甲亢)和無痛性甲狀腺炎(PT)鑒彆中的價值.方法 選取102例Graves甲亢患者和37例PT患者入組.測定所有患者的血清遊離三碘甲狀腺原氨痠(FT3)、遊離甲狀腺素(FT4)、TSH、甲狀腺毬蛋白抗體(TgAb)、甲狀腺過氧化物酶抗體(TPOAb)和促甲狀腺激素受體抗體(TRAb)水平.採用3.0T超導型MRI儀完成MRI檢查,併穫得ADC.測定甲狀腺24 h RAIU,併進行甲狀腺靜態顯像.Graves甲亢患者的病理組織從接受手術的患者中穫取(6例),PT患者的病理組織從接受活檢的患者中穫取(2例).採用Pearson檢驗明確各指標間的相關性,用受試者工作特徵麯線(ROC)分析各項指標的診斷價值,確定各項指標的切分點值,併判斷各項指標的診斷靈敏度、特異度、準確率、暘性預測值和陰性預測值.結果 與PT患者比較,Graves甲亢患者的ADC、TRAb和RAIU顯著升高(t=15.126、7.226和31.574,P均＜0.01).ADC、TRAb和RAIU之間存在顯著的正相關性.ROC顯示,RAIU、ADC和TRAb的麯線下麵積大于0.900.其中,RAIU具有最好的診斷價值,噹最佳切分點值確定為24.500％時,靈敏度、特異度、準確率、暘性預測值和陰性預測值均為100％.ADC比TRAb的診斷價值更高,噹最佳切分點值分彆確定為1.837×10-3 mm2/s和1.350 IU/ml時,ADC的上述統計指標分彆為96.078％、91.892％、95.000％、97.059％和89.474％,TRAb的上述統計指標分彆為88.235％、75.676％、84.892％、90.909％和70.000％.病理組織學結果顯示:Graves甲亢以濾泡增生、濾泡上皮細胞增生以及血管擴張和充血為主要錶現;PT以淋巴細胞浸潤、淋巴濾泡形成以及濾泡破壞為主要錶現.結論 對于Graves甲亢和PT的鑒彆,RAIU、ADC和TRAb均有價值,RAIU最佳、ADC次之.ADC的顯像原理是基于不同疾病細胞密度差異的病生理變化,而RAIU的測定原理是反映不同疾病對碘攝取能力差異的病生理變化.
목적 연구MRI미산가권성상(DWI)적표관미산계수(ADC)、갑상선섭131I솔(RAIU)화혈청지표등재Graves갑상선공능항진증(간칭갑항)화무통성갑상선염(PT)감별중적개치.방법 선취102례Graves갑항환자화37례PT환자입조.측정소유환자적혈청유리삼전갑상선원안산(FT3)、유리갑상선소(FT4)、TSH、갑상선구단백항체(TgAb)、갑상선과양화물매항체(TPOAb)화촉갑상선격소수체항체(TRAb)수평.채용3.0T초도형MRI의완성MRI검사,병획득ADC.측정갑상선24 h RAIU,병진행갑상선정태현상.Graves갑항환자적병리조직종접수수술적환자중획취(6례),PT환자적병리조직종접수활검적환자중획취(2례).채용Pearson검험명학각지표간적상관성,용수시자공작특정곡선(ROC)분석각항지표적진단개치,학정각항지표적절분점치,병판단각항지표적진단령민도、특이도、준학솔、양성예측치화음성예측치.결과 여PT환자비교,Graves갑항환자적ADC、TRAb화RAIU현저승고(t=15.126、7.226화31.574,P균＜0.01).ADC、TRAb화RAIU지간존재현저적정상관성.ROC현시,RAIU、ADC화TRAb적곡선하면적대우0.900.기중,RAIU구유최호적진단개치,당최가절분점치학정위24.500％시,령민도、특이도、준학솔、양성예측치화음성예측치균위100％.ADC비TRAb적진단개치경고,당최가절분점치분별학정위1.837×10-3 mm2/s화1.350 IU/ml시,ADC적상술통계지표분별위96.078％、91.892％、95.000％、97.059％화89.474％,TRAb적상술통계지표분별위88.235％、75.676％、84.892％、90.909％화70.000％.병리조직학결과현시:Graves갑항이려포증생、려포상피세포증생이급혈관확장화충혈위주요표현;PT이림파세포침윤、림파려포형성이급려포파배위주요표현.결론 대우Graves갑항화PT적감별,RAIU、ADC화TRAb균유개치,RAIU최가、ADC차지.ADC적현상원리시기우불동질병세포밀도차이적병생리변화,이RAIU적측정원리시반영불동질병대전섭취능력차이적병생리변화.
Objective To assess the value of apparent diffusion coefficient (ADC) in diffusionweighted imaging (DWI),thyroid radioactive iodine uptake (RAIU)and serum parameters in differential diagnosis between Graves disease(GD)and painless thyroiditis(PT).Methods One hundred and two patients with GD and 37 patients with PT were enrolled.Serum thyroid hormones and antibodies were measured,including free triiodothyronine (FT3),free thyroxine (FT4),TSH,thyroid globulin antibody (TgAb),thyroid peroxidase antibody (TPOAb) and thyrotropin receptor antibody (TRAb).DWI was obtained with a 3.0 T MR scanner,and ADC values were calculated.24 h later RAIU and thyroid sc intigraphy were conducted.Tissue samples were obtained in GD patients (6 cases) after thyroidectomy and in PT patients(2 cases)after biopsy.Pearson bivariate correlation was made.Receiver operating characteristic curves (ROC) were drawn and diagnostic efficacies were determined.Optimal cut-off values were selected,and then sensitivity,specificity,accuracy,positive predictive value and negative predictive value were assessed.Results ADC,TRAb and RAIU were significantly higher in GD than in PT (t=15.126,7.226 and 31.574,with all P＜0.01).And they were closely and positively correlated.ROC showed areas under the curves for RAIU,ADC and TRAb were higher than 0.900.RAIU was the best method to differentiate GD from PT.When cutoff value of RAIU was determined as 24.500 ％,sensitivity,specificity,accuracy,positive predictive value and negative predictive value were all 100％.The above statistical data were 96.078％,91.892％,95.000％,97.059％ and 89.474％ for ADC,and 88.235％,75.676％,84.892％,90.909％ and 70.000％ for TRAb,when the optimal thresholds of 1.837×10-3 mm2/s and 1.350 IU/ml were determined respectively.ADC was better than TRAb.Histopathology results showed that for GD,follicle hyperplasia,follicular epithelial cells hyperplasia,hyper-vascularity and congestive perfusion were characteristic features; while for PT,massive lymphocytic infiltration with hyperplastic germinal center formation and follicle disruption were characteristic features.Conclusions RAIU,DWI and TRAb were all of diagnostic values for differentiation between GD and PT,RAIU was the best method and DWI followed.DWI has great potential for thyroid pathophysiological imaging because it reflects tissue cellularity differences between GD and PT.The principle for RAIU is that it reflects the iodine uptake changes in different diseases.
