^99Tcm-MIBI-SPECT与定位CT融合显像和^18F-FDG-PET/CT融合显像鉴别孤立性肺结节的对比研究  

Comparative analysis of integrated ^(99m)Tc-MIBI-SPECT/localizable CT and integrated ^(18)F-FDGPET/CT for differential diagnosis of solitary pulmonary nodules

作　　者：邓智勇[1,2] 李高峰[1,2] 向旭东[1,2] 贾莉[1,2] 刘超[1,2] 陈婷[1,2] 刘长江 

机构地区：[1]昆明医科大学第三附属医院 [2]云南省肿瘤医院核医学科,云南昆明650118 [3]兴义市人民医院核医学科,贵州兴义562400

出　　处：《南方医科大学学报》2015年第3期422-426,共5页Journal of Southern Medical University

基　　金：云南省教育厅科学研究基金(2013Y282)

摘　　要：目的对比分析99Tcm-MIBI SPECT与定位CT融合显像和18F-FDG-PET/CT融合显像对孤立性肺结节(SPN)的鉴别诊断效率,为中小城市医疗机构寻找一种较为廉价的鉴别SPN诊断方法。方法对39例SPN患者行99Tcm-MIBI-SPECT与定位CT融合显像,46例SPN患者行18F-FDG-PET/CT融合显像。对两种显像结果进行定性及半定量分析。并根据最终诊断结果,对比分析两种显像方法对SPN的鉴别诊断效率。结果 39例SPN患者行99Tcm-MIBI-SPECT与定位CT融合显像,13例为恶性SPN,26例良性SPN。99Tcm-MIBI-SPECT与定位CT融合显像定性分析对SPN良恶性鉴别诊断灵敏度92.31%(12/13)、特异性88.46%(23/26)、准确性89.74%(35/39)、阳性预测值80%(12/15)、阴性预测值95.83%(23/24)。46例SPN患者行18F-FDG-PET/CT融合显像,29例为恶性SPN,17例良性SPN。18F-FDG-PET/CT融合显像对SPN良恶性鉴别诊断灵敏度96.55%(28/29)、特异性76.47%(13/17)、准确性89.13%(41/46)、阳性预测值87.50%(28/32)、阴性预测值92.86%(13/14)。99Tcm-MIBI-SPECT与定位CT融合显像和18F-FDGPET/CT融合显像鉴别SPN的灵敏度(χ2=0.356,P=0.55)、特异性(χ2=1.084,P=0.298)、准确性(χ2=0.008,P=0.927)、阳性预测值(χ2=0.453,P=0.501)和阴性预测值(χ2=0.157,P=0.692)均无统计学差异。受试者工作特征(ROC)曲线分析显示:以99Tcm-MIBI早期摄取比值(EUR)≥1.474为鉴别SPN良恶性界值,灵敏度100%,特异性76.90%;以99Tcm-MIBI延迟摄取比值(DUR)≥1.38为鉴别SPN良恶性界值,灵敏度100%,特异性76.90%;以18F-FDG最大标准摄取比值(SUVmax)≥2.40为鉴别SPN良恶性界值,灵敏度96.60%,特异性76.50%。EUR、DUR与SUVmax的ROC界值诊断灵敏度(Fisher精确检验P值分别为1.0和1.0)、特异性(Fisher精确检验P值分别为1.0和1.0)差异无统计学意义。结论99Tcm-MIBI-SPECT与定位CT融合显像和18F-FDG-PET/CT融合显像对SPN的鉴别诊断效率相似,99Tcm-MIBI-SPECT与定位CT融合显像可作为中小城市中低收入SPN患者较为实用的早�Objective To compare the diagnostic value of99Tcm- MIBI SPECT/localizable CT and18FDG- PET/CT in patients with indeterminate solitary pulmonary nodules（SPNs） and assess the feasibility of using99Tcm- MIBI SPECT/localizable CT as an alternative when18FDG- PET/CT is not available. Methods Thirty- nine patients with indeterminate SPNs were examined by99Tcm-MIBI SPECT/localizable CT, and another 46 patients by18FDG-PET/CT. The findings of the two modalities were analyzed qualitatively and semiquantitatively to assess their efficacy for a definitive diagnosis of SNPs. Results Of the 39 patients examined by^99Tcm- MIBI SPECT/localizable CT, 13 were identified to have malignant SPNs and 26 had benign SPNs; the diagnostic sensitivity, specificity, accuracy, positive predictive value（PPV） and negative predictive value（NPV） of the examination were 92.31%（12/13）, 88.46%（23/26）, 89.74%（35/39）, 80%（12/15） and 95.83%（23/24）, respectively. Of the 46 patients receiving^18FDG- PET/CT examination, 29 malignant cases and 17 benign cases were identified with a diagnostic sensitivity,specificity, accuracy, PPV and NPV of 96.55%（28/29）, 76.47%（13/17）, 89.13%（41/46）, 87.50%（28/32） and 92.86%（13/14）,respectively. The two modalities showed no significant differences in the diagnostic sensitivity（χ^2=0.356, P=0.55）, specificity（χ2=1.084, P=0.298）, accuracy（χ2=0.008, P=0.927）, PPV（χ2=0.453, P=0.501） or NPV（χ2=0.157, P=0.692）. The ROC curve showed that with the early uptake ratio（EUR） of99Tcm- MIBI ≥1.474 and ≥1.38 as the cutoff values, the sensitivity of99Tcm- MIBI SPECT/localizable CT was both 100% and the specificity both 76.90%; with the maximum standard uptake value（SUVmax） of18 FDG ≥2.40 as the cutoff value, the sensitivity of18FDG- PET/CT was 96.60% and the specificity was 76.50%, showing no significant differences between the two modalities in the diagnostic efficacy. Conclusion99Tcm-MIBI-SPECT/ localizable CT may be a useful and practical mod

关 键 词：99TCM-MIBI SPECT 18F-FDG PET/CT X-CT 孤立性肺结节 肺癌 

分 类 号：R563[医药卫生—呼吸系统]