鼻咽癌放射治疗后^(99m)Tc-MIBI SPECT显像的临床价值

^(99m)Tc-MIBI SPECT Imaging in the Follow-up Observation of Nasopharyngeal Carcinoma

目的:评价99mTc-MIBI SPECT显像对鼻咽癌患者放疗后局部残余或复发病灶的鉴别价值。方法:48例经病理证实的原发性鼻咽癌患者于放疗后3个月行99mTc-MIBI SPECT显像,与同期的CT结果对照,并分别计算鼻咽部与头皮的放射性计数比值作为99mTc-MIBI摄取指数(MUI)。以接受器工作特性曲线(ROC)分析确定MUI判别阈值。鼻咽内镜检查、病理活检及18个月的临床随访资料作为鼻咽癌病灶残余或鼻咽癌复发的依据。结果:以MUI≥1.33为阳性标准,99mTc-MIBI SPECT显像监测鼻咽癌病灶残余或复发的敏感度73.33%,特异度93.94%,诊断符合率87.50%。CT监测鼻咽癌病灶残余或复发的敏感度73.33%,特异度84.85%,诊断符合率81.25%。99mTc-MIBI SPECT显像与CT联合鉴别鼻咽癌病灶残余或复发的敏感度、特异度和诊断符合率分别为100%、96.55%和97.30%。结论:99mTc-MIBI SPECT显像对鼻咽癌患者放疗后局部残余或复发病灶的鉴别有一定价值;与CT联合可有效提高对放疗后鼻咽癌病灶残余或复发的早期诊断效能。

Objective：To investigate the diagnostic potential of ^99mTc-sestamibi （MIBI） SPECT in differentiating residual/recurrent lesions after radiotherapy in patients with nasopharyngeal carcinoma （NPC）. Methods： 48 patients with primary NPC histologically confirmed with biopsy underwent ^99mTc-MIBI SPECT at the 3rd month after radiotherapy. All patients had contemporaneous CT studies. In these patients, histopathologic and/or 18 mo clinical follow-up data were used as the gold standard against which the results of the scintigraphic and radiographic studies were compared. Nasopharyngeal-toscalp ratios were obtained as MIBI uptake index （MUD. Receiver operating characteristic analysis was used to define the cut-off of MUI. Results：The optimum cut-off of 1. 33 of MUI was defined with sensitivity of 73. 33%o, specificity of 93. 94 %, and accuracy of 87.50 % for differentiating residual/recurrent lesions from the benign process post radiotherapy, while CT evaluations showed sensitivity of 73.33% ,specificity of 84.85% ,and accuracy of 81.25%. A Combination of CT and ^99mTc-MIBI SPECT for 37 NPC patients with congruent results showed sengitivity of 100 %,specificity of 96.55 % ,and accuracy of 97.30% for differentiating residual/recurrent NPC from benign lesions. Conclusion：^99mTc-MIBI SPECT may play a role in differentiating residual/recurrent lesions after radiotherapy in patients with NPC. The combination of CT and ^99mTcTc-MIBI SPECT can give more accurate diagnosis and differentiation in distinguishing residual/recurrent lesions in the radiotherapy follow-up.