甲状腺平面静态显像平均计数比值法半定量分析的诊断效能  

Diagnostic efficiency of semi-quantitative analysis by mean counting ratio method of thyroid scan

作　　者：张静[1] 连世东[1] 赵峥 Zhang Jing;Lian Shidong;Zhao Zheng(Department of Nuclear Medicine,Dalian Municipal Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院核医学科,116033

出　　处：《中国医师进修杂志》2020年第4期372-375,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨单光子发射计算机断层扫描(SPECT)甲状腺平面静态显像感兴区(甲状腺、本底)平均计数比值法对诊断界定"甲状腺核素摄取过高"的效能,简化以往对甲状腺功能亢进症在单光子发射计算机断层扫描(SPECT)影像表现上的半定量界定方法。方法由两名有经验的副主任医师对大连市中心医院2017年4月至2018年1月就诊的109例患者的甲状腺静态显像结果进行感兴区(甲状腺、本底)勾画及测定其单位面积平均计数的比值,以临床诊断的甲状腺功能亢进症为金标准做参照,利用SPSS17.0统计学软件绘制受试者工作特征曲线(ROC曲线),并计算最佳诊断临界值。以此临界值计算灵敏度、特异度、准确率、阳性及阴性预测值,并分析两名医师诊断的一致性。结果利用两名医师测量结果绘制ROC曲线获得最佳诊断临界点为6.94,并将大于此值作为界定甲状腺摄取锝过高的标准。医师1根据诊断临界点鉴别诊断甲状腺功能亢进症得到的灵敏度、特异度、准确率,分别为86.0%(37/43)、100.0%(66/66)、95.5%(103/109);医师2分别为88.4%(38/43)、100.0%(66/66)、95.4%(104/109)。两名医师比值法诊断一致率为96.6%(86/89),组内相关系数(ICC)值为0.98。结论甲状腺静态显像平均计数比值法为甲状腺锝摄取过高的鉴别诊断提供了比较可靠的半定量界定值,具有较好的应用价值,不同医师独立完成平均计数比值法半定量分析甲状腺锝摄取程度具有良好的一致性,并且实际应用上比以往的介入校正比的甲状腺/本底比值法要简单易行。Objective To assess the diagnostic efficient of mean counting ratio method,and to simplify and improve the semi-quantitative method of defining excessive uptake of thyroid nuclides.Methods One hundred and nine imaging results of thyroid scan in Dalian Municipal Central Hospital from April 2017 to January 2018 were delineated the FOI by two experienced deputy chief physicians and the ratio of average counts per unit area was determined.Clinical diagnosis of hyperthyroidism was used as gold standard,and receptor operation characteristic(ROC)curve was drawn and the optimal diagnostic threshold was calculated.The sensitivity,specificity,accuracy,positive and negative predictive values were calculated and the consistency of the two physicians′diagnosis was analyzed.Results The best diagnostic threshold was 6.94 by drawing ROC curve from the measurements of two physicians.The value greater than this was used as a criterion to define the excessive uptake of technetium in thyroid gland.For doctor 1,the sensitivity,specificity and accuracy of differential diagnosis of hyperthyroidism based on diagnostic threshold were 86.0%(37/43),100.0%(66/66)and 95.5%(103/109),respectively.For doctors 2,they were 88.4%(38/43),100.0%(66/66)and 95.4%(104/109),respectively.The concordance rate was 96.6%(86/89),interclass correlation coefficient(ICC)was 0.98.Conclusions Average counting ratio method provides reliable semi-quantitative cut off value for differential diagnosis of high Tc uptake.It has good application value.Different physicians independently complete the semi-quantitative analysis of Tc uptake by average counting ratio method,which has good consistency.In practice,it is simpler and easier than the thyroid/background ratio method.

关 键 词：甲状腺功能亢进症 体层摄影术 发射型计算机 单光子 放射性核素显像 半定量分析 诊断效能 

分 类 号：R5[医药卫生—内科学]