单光子发射型CT在甲状腺癌术后肿瘤残留检测中的作用

Roles of single photo emission computed tomography-CT in detecting residual tumor from patients with thyroid carcinoma

目的研究^(18)氟-脱氧葡萄糖-单光子发射型计算机断层扫描(^(18)F-deoxyglucose singlephoto emission computed tomography,^(18)F-FDG SPECT)-CT 融合图像对于鉴别肿瘤的良、恶性有很高的灵敏度和特异度。本研究比较了^(18)F-FDG SPECT-CT 和双螺旋高速 CT 在甲状腺癌术后肿瘤残留的检测效率。方法将2004年1月至2005年1月期间收治的56例甲状腺疾病患者分成两组,一组为32例甲状腺肿物患者,另一组为24例甲状腺癌不规范手术后患者。所有的病例术前都行^(18)F-FDGSPECT-CT 和双螺旋高速 CT 检查。结果甲状腺癌不规范手术组中有8例患者两种检查都未发现肿瘤残留而行随诊,其余48例患者行手术治疗,并得到明确的术后病理诊断。根据两种检查结果与术后病理诊断的比较,得出两种检查手段在研究组中的诊断功效:甲状腺肿物组 SPECT-CT 的诊断符合率为87.5%(28/32),约登指数为0.833;CT 的诊断符合率为87.5%(28/32),约登指数为0.667,SPECT-CT 与 CT 检查结果一致的诊断符合率为100%(24/24),约登指数为1,两种检查之间差异有统计学意义,P=0.030;甲状腺癌不规范手术组 SPECT-CT 的诊断符合率为81.3%(13/16),约登指数为0.633;CT 的诊断符合率为75.0%(12/16),约登指数为0.492,SPECT-CT 与 CT 检查结果一致的诊断符合率为84.6%,约登指数为0.675,两种检查之间差异有统计学意义,P=0.035。结论在甲状腺肿物诊断中 SPECT-CT 和 CT 有相同的诊断功效并有良好的协同作用,当两者诊断相符时,诊断功效最大;在甲状腺癌不规范手术后肿瘤残留检测中,SPECT-CT 发现残留病灶的能力与双高速螺旋 CT相比有明显提高,可作为目前检测甲状腺癌术后是否有残留病灶的有效手段。

Objective As newly, functional, diagnostic measure-^18 F-deoxyglucose single photo emission computed tomography （^18F-FDG SPECT-CT ） has well sensitivity and specialty , it was proved availability in differentiating benign and malignant tumor. In this study, it was compared the efficiency of detecting residual tumor of thyroid cancer between ISF-FDG SPECT-CT and CT-TWIN. Methods During May 2004 to August 2004, 56 patients with thyroid disease were divided into two groups, one group was 32 cases suffered thyroid tumor, another was 24 cases suffered improper operation. All cases must take ^18 F-FDG SPECT-CT and CT-TWIN. Results Forty eight cases had been performed operation, and 8 cases waited and watched because they didn＇t be found residual tumor by ISF-FDG SPECT-CT and CT-TWIN. The results in detecting thyroid tumor showed that the same rate of diagnostic correction of SPECT-CT was 87.5% （28/32）, and the Youden index of SPECT-CT was 0.667, higher than that of CT which was 87. 5% （28/32） and 0. 633 respectively. When the results two methods were accordant, the rate of diagnostic correction was 100% （24/24）, and Youden index was 1, and the result had statistic signification. The rate of diagnostic correction of SPECT-CT in detecting residual tumor was 84. 6%, and its Youden index was 0. 675. The rate of diagnostic correction of CT in detecting residual tumor was 75.0% , and its Youden index was 0. 492 ; and the result had statistics signification by being compared two different measures. Conclusions SPECT-CT and CT all had higher diagnostic efficacy, and they could promote the diagnostic efficacy when they have the same diagnosis in detecting thyroid tumor. The rate of detecting residual tumor of SPECT-CT was 81.3% , compared with that of CT the diagnostic efficacy has greater raise.