^99mTc-MIBI SPECT/CT单独及其联合MSCT在孤立性肺结节定性诊断中的应用价值  

Application value of^99mTc-MIBI SPECT/CT alone and its combination with MSCT in qualitative diagnosis of solitary pulmonary nodules

作　　者：李宗 朱远 朱辉 候先存 李智勇 LI Zong;ZHU Yuan;ZHU Hui;HOU Xian-cun;LI Zhi-yong(Department of Nuclear Medicine,the First People′s Hospital of Lianyungang,Lianyungang 222000,China;Department of Nuclear Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]江苏省连云港市第一人民医院核医学科,连云港市222000 [2]徐州医科大学附属医院核医学科,江苏省徐州市221000

出　　处：《广西医学》2020年第6期694-697,744,共5页Guangxi Medical Journal

摘　　要：目的探讨^99mTc标记的甲氧基异丁基异腈(^99mTc-MIBI)单光子发射计算机断层成像术(SPECT)/CT单独及其联合多层螺旋CT(MSCT)在孤立性肺结节(SPN)定性诊断中的应用价值。方法纳入180例SPN患者,包括62例良性SPN和118例恶性SPN,均行^99mTc-MIBI SPECT/CT和MSCT检查。比较良性和恶性SPN患者MSCT的典型征象,以及^99mTc-MIBI SPECT/CT早期相放射性摄取比值(EUR)和延迟相放射性摄取比值(DUR)。采用受试者工作特征曲线分析EUR和DUR诊断恶性SPN的效能,比较^99mTc-MIBI SPECT/CT单独及联合MSCT诊断恶性SPN的敏感度、特异度、准确度、阳性预测值以及阴性预测值。结果与恶性患者相比,良性患者的毛刺征、分叶征、空泡征、支气管充气征、血管集束征、胸膜牵拉征、直径>20 mm的SPN比例更低,钙化SPN比例更高(均P<0.05)。良性SPN的EUR、DUR均低于恶性SPN(均P<0.05),EUR诊断恶性SPN的曲线下面积、灵敏度、特异度分别为0.80、82.3%、72.9%,而DUR分别为0.79、79.0%、66.9%。^99mTc-MIBI SPECT/CT联合MSCT诊断恶性SPN的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为94.1%、90.3%、92.8%、94.9%、88.9%,均高于单独的^99mTc-MIBI SPECT/CT(均P<0.05)。结论^99mTc-MIBI SPECT/CT对SPN良恶性鉴别具有一定的价值,但其联合MSCT可提高定性诊断的效能。Objective To explore the application value of 99 mTc-methoxyisobutylisonitrile(99 mTc-MIBI)single-photon emission computed tomography(SPECT)/CT alone and its combination with multi-slice spiral CT(MSCT)in the qualitative diagnosis of solitary pulmonary nodules(SPN).Methods A total of 180 patients with SPN including 62 benign SPN and 118 malignant SPN were enrolled,and all underwent 99 mTc-MIBI SPECT/CT and MSCT examinations.The typical signs of MSCT,as well as early uptake ratio(EUR)and delayed uptake ratio(DUR)of 99 mTc-MIBI SPECT/CT were compared between patients with benign SPN and malignant SPN.Receiver operating characteristic curve was applied to analyzing the diagnostic efficacy of EUR and DUR for malignant SPN,and the sensitivity,specificity,accuracy rate,positive and negative predictive values for diagnosing malignant SPN were compared between 99 mTc-MIBI SPECT/CT and 99 mTc-MIBI SPECT/CT combined with MSCT.Results As compared with the malignant patients,the benign patients possessed a lower proportion of SPN with spiculation sign,lobulation sign,vacuole sign,air bronchogram,vascular convergence sign,pleural tail sign,or diameter more than 20 mm,whereas a higher proportion of SPN with calculation(all P<0.05).The EUR and DUR in the benign SPN were lower than those in the malignant SPN(all P<0.05),for diagnosing malignant SPN,the area under the curve of EUR was 0.80 with a sensitivity of 82.3%and a specificity of 72.9%,and the area under the curve of DUR was 0.79 with a sensitivity of 79.0%and a specificity of 66.9%.For diagnosing malignant SPN,the combination of 99 mTc-MIBI SPECT/CT with MSCT obtained higher sensitivity,specificity,accuracy rate,positive and negative predictive values(94.1%,90.3%,92.8%,94.9%and 88.9%,respectively)than 99 mTc-MIBI SPECT/CT alone(all P<0.05).Conclusion 99 mTc-MIBI SPECT/CT has a certain value in differentiation between benign and malignant SPN,and its combination with MSCT can improve the efficacy of qualitative diagnosis.

关 键 词：孤立性肺结节 甲氧基异丁基异腈 单光子发射型计算机断层成像 多层螺旋计算机断层成像 鉴别 效能 

分 类 号：R445.3[医药卫生—影像医学与核医学]