^(131)I-MIBG SPECT/CT不同时间及本底在嗜铬细胞瘤中的诊断价值比较  

Comparison of diagnostic value of ^(131)I-MIBG SPECT/CT at different time points and backgrounds in pheochromocytoma

作　　者：左睿 刘双 庞华[1] 许璐[1] 田方芳 ZUO Rui;LIU Shuang;PANG Hua(Department of Nuclear Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院核医学科,重庆400016

出　　处：《放射学实践》2023年第10期1320-1326,共7页Radiologic Practice

基　　金：重庆市科卫联合医学科研项目(2021MSXM087)。

摘　　要：目的:探究^(131)I-MIBG SPECT/CT在鉴别肾上腺嗜铬细胞瘤(PCC)及皮质腺瘤(CA)的应用价值及不同采集时间和本底的影响。方法:回顾性搜集2014年3月-2021年11月于行^(131)I-MIBG SPECT/CT显像并取得术后病检的所有患者相关临床及影像学资料。共纳入53例患者,包括24例PCC,12例副神经节瘤(PGL)和17例CA,比较^(131)I-MIBG SPECT/CT融合图像中PCC、CA及PGL 3组间病灶MIBG的摄取及形态差异;正常肾上腺组织也可能少量摄取MIBG,故本研究选取34例左侧正常肾上腺作为对照组,比较其与所有肾上腺病灶的MIBG摄取差异。采用受试者工作特征(ROC)曲线分析^(131)I-MIBG SPECT/CT相关指标的诊断效能,并比较^(131)I-MIBG SPECT/CT在不同时间、不同本底的诊断效能有无差异。结果:①31名患者同时行24 h、48 h的^(131)I-MIBG SPECT/CT,发现24 h显像对肾上腺病灶的诊断及PCC和CA的鉴别能力均更佳,曲线下面积均为0.90。②^(131)I-MIBG半定量指标在肾上腺病灶和正常对照组及PCC和CA间的差异有统计学意义(P<0.05),T/M(tumor/mediastinum)诊断诊断肾上腺病灶的效能较高(临界值=2.26,AUC=0.89),T/Lu tumor/right upper lobe of liver)鉴别PCC和CA的效能较高(临界值=1.4,AUC=0.86),不同本底的选择对诊断肾上腺病灶及鉴别PCC和CA的曲线下面积差异无统计学意义。③联合T/Lu-24 h及CT值mean在区分PCC和CA两者的效能较单一指标更佳,AUC为0.89。结论:^(131)I-MIBG SPECT/CT在诊断肾上腺病灶及鉴别嗜铬细胞瘤与皮质腺瘤的效能较高,联合SPECT和CT的指标可进一步提高鉴别效能,但不同采集时间及本底的选择对诊断效能无明显影响。Objective:To investigate the diagnostic value of ^(131)I-MIBG SPECT/CT in differentiating pheochromocytoma(PCC)from cortical adenoma(CA)and assess the impact of different acquisition times and backgrounds.Methods:We retrospectively collected clinical and imaging data from patients who underwent ^(131)I-MIBG SPECT/CT imaging and subsequent pathological examinations between March 2014 to November 2021.Our study included 53 patients,comprising 24 with PCC,12 with PGL and 17 with CA.We compared differences in MIBG uptake and morphology among PCC,CA and PGL in ^(131)I-MIBG SPECT/CT fusion image.Since normal adrenal tissue may exhibit slight MIBG uptake,we selected 34 left normal adrenal glands as the control group and analyzed differences in MIBG uptake between left normal adrenal glands and all adrenal lesions.We assessed the diagnostic efficacy of ^(131)I-MIBG SPECT/CT related parameters using receiver operating characteristic(ROC)curves and compared the diagnostic performancee of ^(131)I-MIBG SPECT/CT at different acquisition times and backgrounds settings.Results:①Among the 31 patients who underwent ^(131)I-MIBG SPECT/CT imaging at 24 hours and 48 hours,the 24-hour image demonstrated superior diagnostic accuracy for adrenal lesions and the ability to differentiate PCC from CA,withe an area under the curve(AUC)of 0.90.②Significant differences were observed in semi-quantitative indices derived from ^(131)I-MIBG SPECT/CT between adrenal lesions and normal controls,as well as between PCC and CA(P<0.05).Tumor/Mediastinum(T/M)was more effective in the diagnosing adrenal lesions(cut-off value=2.26,AUC=0.89),while Tumor/right upper lobe of Liver(T/Lu)was more effective in distinguishting PCC from CA(cut-off value=1.40,AUC=0.86).There was no significant difference in AUC values betweeen different background settings for diagnosing adrenal lesions and differentiating PCC from CA.③Combining T/Lu-24h and the mean CT value improved the differentiation of PCC from CA with an AUC of 0.89.Conclusion:^(131)I-MIBG SPECT/CT is

关 键 词：嗜铬细胞瘤 肾上腺皮质腺瘤 诊断 鉴别 正电子发射体层摄影术 体层摄影术 X线计算机 

分 类 号：R736.6[医药卫生—肿瘤] R447[医药卫生—临床医学] R445.6R814.4