^(18)F-FDG PET/CT显像对甲状腺偶发结节的诊断价值  

The Clinical Value of ^(18)F-FDG PET/CT Imaging in the Diagnosisof Thyroid Incidentaloma

作　　者：吉婷[1] 杨爱民[1] JI Ting;YANG Aimin(Department of Nuclear Medicine,the First Affiliated Hospital,Medical School of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学医学院第一附属医院核医学科,陕西西安710061

出　　处：《标记免疫分析与临床》2023年第11期1846-1852,共7页Labeled Immunoassays and Clinical Medicine

基　　金：陕西省自然科学基金(P-糖蛋白及其逆转剂对肿瘤^(18)F-FDG摄取影响的实验研究)(编号:2017JM8005)。

摘　　要：目的探讨18氟-脱氧葡萄糖(^(18)F-FDG)正电子发射计算机断层扫描(PET/CT)显像对甲状腺偶发结节的鉴别诊断价值及甲状腺结节为恶性病变的相关危险因素。方法将从2012年1月至2020年10月期间在西安交通大学第一附属医院行^(18)F-FDG PET/CT显像并发现甲状腺机会瘤的患者纳入研究,以穿刺后细胞学诊断或外科手术后病理结果为金标准,分析最大标准摄取值(SUVmax)的诊断价值,并分析甲状腺结节为恶性病变的危险因素。结果58例经金标准最终确诊的患者参与了本研究,其中良性12例,恶性46例[分化型甲状腺癌(DTC)30例,65.20%]。恶性病灶的SUVmax均值明显高于良性病灶,两者间差异存在统计学意义(P<0.001)。当SUVmax截断值为3.045时,^(18)F-FDG PET/CT显像诊断灵敏度和特异性分别为76.10%和75.00%。当SUVmax大于7时,阳性预测值达到100.00%。但由于恶性病灶大小与SUVmax间存在相关性,故当病灶较小且SUVmax值较低时临床需要谨慎处理。表现为局灶性^(18)F-FDG摄取异常的病灶,其为恶性病变的危险性较弥漫性^(18)F-FDG摄取异常及仅CT表现异常的病灶更高(P=0.047)。结论SUVmax是甲状腺机会瘤鉴别诊断的一个重要指标。当病灶较小且SUVmax值较低,不能排除恶性病变的可能,临床需要谨慎处理。局灶性^(18)F-FDG摄取增高的病灶,恶性风险高于弥漫性^(18)F-FDG摄取增高的病灶,CT表现为低密度的病灶,仍需考虑甲状腺恶性肿瘤的可能,尤其是甲状腺微小乳头状癌。Objective To investigate the differential diagnostic value of ^(18)F-fluorodeoxyglucose(^(18)F-FDG)positron emission computed tomography(PET/CT)imaging in incidental thyroid nodules and to identify related risk factors.Methods Patients who underwent ^(18)F-FDG PET/CT imaging in the First Affiliated Hospital of Xi’an Jiaotong University from January,2012 to October,2020 were retrospectively analyzed.The cytology results of fine needle aspiration(FNA)strategy or the histopathologic diagnosis of thyroidectomy were regarded as the golden criteria.The value of maximum uptake value(SUVmax)in the diagnosis of thyroid incidentaloma was comprehensively evaluated.Furthermore,the related risk factors for thyroid malignant incidentaloma were studied.Results 58 patients were fully confirmed by the gold standard participated in this study:12 were benign and 46 were malignant(30 were differentiated thyroid cancer(DTC),65.20%).The mean SUVmax of malignant lesions was significantly higher than that of benign lesions(P<0.001).Using the SUVmax cutoff value of 3.045,the diagnostic sensitivity and specificity of ^(18)F-FDG PET/CT imaging were 76.10%and 75.00%,respectively.When the SUVmax was greater than 7,the positive predictive value reached 100.00%.However,due to the correlation between malignant lesion size and SUVmax,clinical treatment should be carefully planned when the lesion was small and the SUVmax value was low.Those with abnormal focal ^(18)F-FDG uptake showed a higher risk of malignant lesions than those with abnormal diffuse ^(18)F-FDG uptake and only with abnormal CT findings(P=0.047).Conclusion Our results suggest that SUVmax is an important indicator in the differential diagnosis of thyroid opportunistic tumor.When the lesion is small and the SUVmax value is low,the possibility of malignant lesions cannot be excluded,and clinical treatment should be carefully planned.Lesions with increased focal ^(18)F-FDG uptake have a higher malignant risk than those with increased diffuse ^(18)F-FDG uptake,and CT shows low-densi

关 键 词：18氟-脱氧葡萄糖 正电子发射计算机断层扫描 甲状腺机会瘤 最大标准摄取值 

分 类 号：R817.4[医药卫生—影像医学与核医学]