^99mTc-DTPA眼眶SPECT/CT评价甲状腺相关性眼病活动性  

Evaluation of the activity in thyroid associated ophthalmopathy with ^(99m)Tc-DTPA SPECT/CT

作　　者：罗莎[1] 王爽[1] 李眉[1] 刘黎洁[1] 信中[2] LUO Sha;WANG Shuang;LI Mei;LIU Li-jie;XIN Zhong(Department of Nuclear Medicine;Department of Endocrinology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院,核医学科,100730 [2]首都医科大学附属北京同仁医院,内分泌科,100730

出　　处：《眼科》2018年第5期344-348,共5页Ophthalmology in China

摘　　要：目的探讨^(99m)Tc-二乙烯三胺五乙酸(DTPA)眼眶SPECT/CT评价甲状腺相关性眼病(TAO)活动性的价值。设计回顾性病例系列。研究对象104例TAO患者(191眼受累)。方法行^(99m)Tc-DTPA眼眶SPECT/CT,对图像进行视觉分析及半定量分析;同时进行临床活动性评分(CAS)。主要指标视觉分析结果(阅片结果、示踪剂摄取增高范围N)、半定量分析结果(球后区与枕部颅骨示踪剂摄取比值URP、眶前区与枕部颅骨示踪剂摄取比值URA)、CAS。结果 TAO活动期眼眶示踪剂摄取增高,非活动期眼眶无示踪剂摄取或仅轻度摄取;以阅片结果为标准,活动期眼眶URP、URA、CAS均显著高于非活动期(P均<0.001);以CAS为标准,活动期眼眶URP、URA、N均显著高于非活动期(P均<0.001);URP、URA、N与CAS之间呈正相关(r=0.47、0.42、0.55,P均<0.001);阅片结果与CAS在评估TAO活动性方面具有一致性(Kappa值0.373),但已治疗TAO的一致性(Kappa值0.256)明显低于未治疗TAO(Kappa值0.565);CAS<3的受累眼中54.7%(47/86)阅片结果判读为活动期,其中97.9%(46/47)眼眶N值为1～3。结论 ^(99m)TC-DTPA眼眶SPECT/CT在评价TAO活动性方面具有良好的临床应用价值,可作为CAS的有效补充。Objective To explore the value of ^99mTc-diethylenetriaminepentaacetic acid （DTPA） SPECT/CT in evaluating the ac- tivity of thyroid associated ophthalmopathy（TAO）. Design Retrospective case series. Participants 104 patients with TAO （191 afflicted eyes）. Methods Orbital ^99mTc-DTPA SPECT/CT and the clinical activity score （CAS） were separately performed to patients. Main Out- come Measures The results of film-reading, the area of high uptake （N）, an uptake radio between the posterior orbit and the occipital （URP）, an uptake radio between the anterior orbit and the occipital （URA）, and CAS. Results There were high uptake in active TAO, but low uptake or no uptake in inactive TAO. URP, URA, CAS in active TAO were significantly higher than those in inactive TAO ac- cording to the results of film-reading （P〈0.001）. URP, URA, N in active TAO were significantly higher than those in inactive TAO ac- cording to CAS （P〈0.O01）. There was a positive correlation between URP, URA, N and CAS （r=0.47, 0.42, 0.55 respectively and all P〈 0.001）. There was consistency between ^99mTc-DTPA SPECT/CT and CAS （Kappa=0.37）, but this consistency reduces in treated TAO. There were 54.7% of orbits with CAS〈3 presenting high uptake, of which 97.9% orbits＇ values were from 1 to 3. Conclusion As a com- plement to the CAS, ^99mTc-DTPA SPECT/CT has good clinical application value in evaluating the activity of TAO.

关 键 词：甲状腺相关性眼病 二乙烯三胺五乙酸 放射性核素显像 

分 类 号：R581[医药卫生—内分泌] R771.3[医药卫生—内科学] R817.4[医药卫生—临床医学]