SPECT/CT诊断分化型甲状腺癌^(131)I清甲治疗后淋巴结转移及ROC分析  

Clinical research of SPECT/CT imaging for evaluating lymph node metastasis after ^(131)I ablation in patients with DTC

作　　者：程旭[1] 李永军[1] 徐兆强[1] 袁孝军[1] 许昕丹 包丽华[1] 

机构地区：[1]南京医科大学第一附属医院核医学科,江苏南京210029

出　　处：《医学影像学杂志》2017年第1期36-39,66,共5页Journal of Medical Imaging

摘　　要：目的探讨治疗量131I SPECT/CT在评价分化型甲状腺癌(DTC)局部淋巴结转移中的价值。方法回顾性分析155例接受首次清甲治疗的DTC术后患者,其中男36例,女119例,平均年龄(40.3±13.48)岁。131I治疗剂量(108.26±24.15)m Ci,治疗后完成131I全身平面显像(Rx WBS)和SPECT/CT显像。根据Rx WBS结果将155例患者分为2组,一组为Rx WBS示单纯残甲,另一组为Rx WBS示"残甲伴可疑淋巴结转移"。结果 Rx WBS示单纯残甲的119例患者中,SPECT/CT仍为单纯残甲者108例(90.76%),另11例(9.24%)除见残甲外还发现局部淋巴结转移。受试者曲线分析(ROC)结果显示,对于Rx WBS示单纯残甲的患者,当刺激后Tg值为5.905ng/ml时,SPECT/CT提供额外诊断淋巴结转移的准确性最高,敏感性为72.7%,特异性为78.7%,AUC为0.818。在Rx WBS示残甲伴可疑淋巴结转移的36例患者中,SPECT/CT结果仅见残甲者14例(38.9%);其余22例SPECT/CT图像上可见颈部或纵膈淋巴结转移,且有8例SPECT/CT图像上发现比Rx WBS所示更多的转移淋巴结。结论在Rx WBS的基础上,SPECT/CT有助于发现和鉴别更多的局部转移性淋巴结。Objective To investigate clinical value of SPECT/CT fusion imaging for evaluating lymph node metastasis after 131I ablation in DTC. Methods 155 patients （36 males and 119 females） performed first 131I ablation were included in our stud- y. Average age of patients was 40.3 ± 13.48 and average （lose of 131 I was （ 108.26 ± 24.15） mCi. 80 - 96 hours after oral 131 I, all patients performed 131I whole-body planar imaging （RxWBS） and SPECT/CT fusion imaging, ll5 patients were divided into two groups based on the finding of RxWBS. The result of RxWBS showed solo remnant thyroid tissue were regarded as group one （REM） , and the result of RxWBS showed remnant thyroid tissue and suspected lymph node metastasis were regarded as group two （LN）. Results For REM group, 108 patients （90. 76% ） showed solo remnant based on SPECT/CT images, l l patients （9.24%） showed additional local LN metastases. The result of ROC showed accuracy of SPECT/CT for diagnosing metastatic LN was relative high, the sensitivity＂ and specificity were 72.7% and 78.7% , AUC was 0. 818. For LN group, only 14 patients （38.9%） showed solo remnant. The other 22 patients showed LN metastases on SPECT/CT images. Of the 22 patients, 8 pa- tients were discovered additional LN metastases compared to the result of RxWBS. Conclusion SPECT/CT fusion imaging can do help to find more local metastatic LN compared to the conventional RxWBS for DTC patients with radionuclide iodine treatment.

关 键 词：体层摄影术 发射型计算机 单光子 分化型甲状腺癌 融合显像 甲状腺球蛋白 

分 类 号：R817.4[医药卫生—影像医学与核医学]