~（99m）Tc（V）-DMSA与~（99m）Tc-MIBI显像对甲状腺冷结节良恶性诊断的对比研究
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摘要
目的探讨99mTc(V)-DMSA与99mTc-MIBI亲肿瘤显像对甲状腺冷结节良性与恶性鉴别诊断的临床应用价值。
方法40例甲状腺99mTcO4-核素显像为“冷结节”患者随机分为两组,99mTc(V)-DMSA组21例,99mTc-MIBI组19例。分别于肘静脉注射740～925MBq 99mTc(V)-DMSA和99mTc-MIBI后15min、2h时的采集早期显像、延迟显像。早期显像、延迟显像后采用定性法及半定量分析方法判断甲状腺“冷结节”良、恶性病变的性质。
结果①,定性分析：99mTc(V)-DMSA显像组共有10例恶性病变,99mTc(V)-DMSA显像阳性2例,显像阴性8例,99mTc—MIBI显像组共有9例恶性病变,99mTc—MIBI显像阳性7例、阴性2例；两种显像剂定性诊断甲状腺癌差异有统计学意义(P<0.05)。②,半定量分析：99mTc(V)-DMSA显像组,恶性病变的早期比值(ER)为1.03±0.29,良性病变ER为0.84±0.18,两者之间差别无统计学意义(P>0.05)；恶性病变的延迟比值(DR)为1.29±0.43,良性病变DR为0.99±0.16,两者间差别有统计学意义(P<0.05)。以良性病变延迟相DR的均值±标准差为诊断阈值,诊断显像阳性3例,显像阴性7例；99mTc-MIBI显像组,恶性病变的早期比值(ER)为1.19±0.19,良性病变为1.05±0.28,两者之间差别无统计学意义(P>0.05)；恶性病变的延迟比(DR)为1.67±0.23,良性病变为1.16±0.31,两者之间差别有统计学意义(P<0.05)。以良性病变延迟相DR的均值±标准差为诊断阈值,诊断显像阳性8例,显像阴性1例,两种显像剂半定量分析诊断甲状腺癌差异有统计学意义(P<0.05)。③,以半定量分析结果为准,99mTc(V)-DMSA诊断甲状腺癌灵敏度为30.0%,特异性为100.0%,总符合率为66.7%,Kappa值为0.31。99mTc-MIBI诊断甲状腺癌灵敏度为88.9%,特异性为90.0%,总符合率为90.3%,Kappa值为0.789。
结论99mTc-MIBI甲状腺亲肿瘤显像能够较好的诊断甲状腺癌,其灵敏度、特异性均明显优于99mTc(V)-DMSA。99mTc-MIBI显像对甲状腺结节良恶性鉴别诊断有较大的临床应用价值。
Purpose To evaluate the clinical value of 99mTc-DMSA and 99mTc-MIBI scintigraphy in differentiating thyroid carcinoma from cold nodule. Methods 40 patients with thyroid cold nodule were randomly divided into a 99mTc-DMSA scintigraphy group with 21 cases and a 99mTc-MIBI scintigraphy group with 19 cases. The early image and delay image were acquired 15 minutes and 2 hours after drug was injected into ulnar vein. The qualitative analysis and half-quantitative analysis by ROI were adopted to estimate the property of nodules. Results 1,10 cases of malignant tumor were found in 99mTc (V)-DMSA scintigraphy group by pathology, and 9 cases of malignant tumor were found in 99mTc MIBI scintigraphy group by pathology finally.2 positive cases and 8 negative cases were detected by 99mTc (V)-DMSA with qualitative analysis, and 7 positive cases and 2 negative cases were detected by Tc-MIBI with qualitative analysis. Difference between them has statistical significance (P<0.05) 2, In 99mTc(V)-DMSA group, the early ratio of malignant lesions and innocence lesions were 1.03±0.29 and 0.84±0.18 respectively, which achieved no statistical difference (P>0.05); And the delay ratio of malignant lesions and innocence lesions were 1.29±0.43 and 0.99±0.16 respectively, whose difference had statistical significance(P<0.05). 3 positive cases and 7 negative cases were diagnosed by half-quantitative analysis when the Mean±SD of DR in innocence lesions was set as the threshold. In 99mTc-MIBI group, the early ratio of malignant lesions and innocence lesions were 1.19±0.19 and 1.05±0.28 respectively, which achieved no statistical difference (P>0.05); And the delay ratio of malignant lesions and innocence lesions were 1.67±0.23 and 1.16±0.31 respectively, whose difference had statistical significance (P<0.05).8 positive cases and 1 negative case were diagnosed by half-quantitative analysis when the Mean±SD of DR in innocence lesions was set as the threshold.3, When the half-quantitative results were set as standard, the sensitivity and specificity of 99mTc (V)-DMSA were 30% and 100% respectively, and total coincidence were 66.7% and Kappa is 0.31. The sensitivity and specificity of 99mTc-MIBI is 88.9% and 90% respectively, and total coincidence is 90.3% and Kappa is 0.789. Conclusion The sensitivity and specificity of 99mTc-MIBI scintigraphy are superior to that of 99mTc (V)-DMSA scintigraphy, and the 99mTc-MIBI has important clinical value in differentiate thyroid carcinoma from cold nodule.
方法40例甲状腺99mTcO4-核素显像为“冷结节”患者随机分为两组,99mTc(V)-DMSA组21例,99mTc-MIBI组19例。分别于肘静脉注射740～925MBq 99mTc(V)-DMSA和99mTc-MIBI后15min、2h时的采集早期显像、延迟显像。早期显像、延迟显像后采用定性法及半定量分析方法判断甲状腺“冷结节”良、恶性病变的性质。
结果①,定性分析：99mTc(V)-DMSA显像组共有10例恶性病变,99mTc(V)-DMSA显像阳性2例,显像阴性8例,99mTc—MIBI显像组共有9例恶性病变,99mTc—MIBI显像阳性7例、阴性2例；两种显像剂定性诊断甲状腺癌差异有统计学意义(P<0.05)。②,半定量分析：99mTc(V)-DMSA显像组,恶性病变的早期比值(ER)为1.03±0.29,良性病变ER为0.84±0.18,两者之间差别无统计学意义(P>0.05)；恶性病变的延迟比值(DR)为1.29±0.43,良性病变DR为0.99±0.16,两者间差别有统计学意义(P<0.05)。以良性病变延迟相DR的均值±标准差为诊断阈值,诊断显像阳性3例,显像阴性7例；99mTc-MIBI显像组,恶性病变的早期比值(ER)为1.19±0.19,良性病变为1.05±0.28,两者之间差别无统计学意义(P>0.05)；恶性病变的延迟比(DR)为1.67±0.23,良性病变为1.16±0.31,两者之间差别有统计学意义(P<0.05)。以良性病变延迟相DR的均值±标准差为诊断阈值,诊断显像阳性8例,显像阴性1例,两种显像剂半定量分析诊断甲状腺癌差异有统计学意义(P<0.05)。③,以半定量分析结果为准,99mTc(V)-DMSA诊断甲状腺癌灵敏度为30.0%,特异性为100.0%,总符合率为66.7%,Kappa值为0.31。99mTc-MIBI诊断甲状腺癌灵敏度为88.9%,特异性为90.0%,总符合率为90.3%,Kappa值为0.789。
结论99mTc-MIBI甲状腺亲肿瘤显像能够较好的诊断甲状腺癌,其灵敏度、特异性均明显优于99mTc(V)-DMSA。99mTc-MIBI显像对甲状腺结节良恶性鉴别诊断有较大的临床应用价值。
Purpose To evaluate the clinical value of 99mTc-DMSA and 99mTc-MIBI scintigraphy in differentiating thyroid carcinoma from cold nodule. Methods 40 patients with thyroid cold nodule were randomly divided into a 99mTc-DMSA scintigraphy group with 21 cases and a 99mTc-MIBI scintigraphy group with 19 cases. The early image and delay image were acquired 15 minutes and 2 hours after drug was injected into ulnar vein. The qualitative analysis and half-quantitative analysis by ROI were adopted to estimate the property of nodules. Results 1,10 cases of malignant tumor were found in 99mTc (V)-DMSA scintigraphy group by pathology, and 9 cases of malignant tumor were found in 99mTc MIBI scintigraphy group by pathology finally.2 positive cases and 8 negative cases were detected by 99mTc (V)-DMSA with qualitative analysis, and 7 positive cases and 2 negative cases were detected by Tc-MIBI with qualitative analysis. Difference between them has statistical significance (P<0.05) 2, In 99mTc(V)-DMSA group, the early ratio of malignant lesions and innocence lesions were 1.03±0.29 and 0.84±0.18 respectively, which achieved no statistical difference (P>0.05); And the delay ratio of malignant lesions and innocence lesions were 1.29±0.43 and 0.99±0.16 respectively, whose difference had statistical significance(P<0.05). 3 positive cases and 7 negative cases were diagnosed by half-quantitative analysis when the Mean±SD of DR in innocence lesions was set as the threshold. In 99mTc-MIBI group, the early ratio of malignant lesions and innocence lesions were 1.19±0.19 and 1.05±0.28 respectively, which achieved no statistical difference (P>0.05); And the delay ratio of malignant lesions and innocence lesions were 1.67±0.23 and 1.16±0.31 respectively, whose difference had statistical significance (P<0.05).8 positive cases and 1 negative case were diagnosed by half-quantitative analysis when the Mean±SD of DR in innocence lesions was set as the threshold.3, When the half-quantitative results were set as standard, the sensitivity and specificity of 99mTc (V)-DMSA were 30% and 100% respectively, and total coincidence were 66.7% and Kappa is 0.31. The sensitivity and specificity of 99mTc-MIBI is 88.9% and 90% respectively, and total coincidence is 90.3% and Kappa is 0.789. Conclusion The sensitivity and specificity of 99mTc-MIBI scintigraphy are superior to that of 99mTc (V)-DMSA scintigraphy, and the 99mTc-MIBI has important clinical value in differentiate thyroid carcinoma from cold nodule.
引文
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[3]Dworkin,Meier,Kaplan,et al. Advances in thyroid disease management [J].Seminars in Nuclear medicine,2006,3:210
[4]冯国伟,杨忠毅,田伟家等.99mTc-甲氧基异丁基异腈双时相核素显像对甲状腺结节良、恶性鉴别的价值探讨[J]内科理论与实践2008.3(3)；186-187
[5]陈清勇,郭勇,吴玉泉等.甲状腺恶性肿瘤经B超、CT检查误诊分析[J]临床误诊误治2000.13(6)；465-466
[6]陈辉,屈婉莹,李伟等,甲状腺99mTc-MIBI显像鉴别甲状腺单发冷结节良恶性的价值[J]中国医学影像学技术199915(6)：447-448
[7]Ohta H et al:J Nucl Med [M] 1984.25:323
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