^(131)I-MIBG显像诊断嗜铬细胞瘤

Application of ^(131)I-MIBG scintigraphy in diagnosis of pheochromocytoma

目的探讨131I-MIBG显像诊断嗜铬细胞瘤的临床价值。方法430例临床疑似嗜铬细胞瘤的患者接受131I-MI-BG全身显像,其中接受B超、CT和MR检查者分别有326、400和77例,接受病理检查者178例。结果430例患者中108例确诊为嗜铬细胞瘤,89例131I-MIBG显像阳性,阴性19例。131I-MIBG显像诊断嗜铬细胞瘤的敏感性、特异性和准确性分别为82.41%、100%和95.70%;对单侧肾上腺病灶、双侧肾上腺病灶、异位病灶以及恶性病灶的检出率分别为90.00%(54/60)、45.45%(5/11)、85.71%(24/28)以及66.67%(6/9)。在所有患者、同时具有临床症状(高血压或头痛、心悸、大汗三联征中至少一项)和阳性常规影像学检查结果(B超、CT或MR至少一项为阳性)的患者以及同时具有临床症状、阳性24小时尿儿茶酚胺和阳性常规影像学检查结果的患者中,131I-MIBG显像的阳性率分别为20.69%、35.15%以及64.58%,差异有统计学意义。59例肾上腺意外瘤中确诊为嗜铬细胞瘤10例,131I-MIBG显像阳性8例。结论131I-MIBG显像是嗜铬细胞瘤首选的确诊方法,但不宜将其作为筛选方法。

Objective To assess the clinical value of 131^I-metaiodobenzylguanidine （MIBG） scintigraphy in pheochromocytoma. Methods A total of 430 patients with clinically suspected pheochromocytoma underwent 131^I-MIBG whole body seintigraphy, 326 among them underwent D-ultrasound, 400 for CT and 77 for MR examination respectively. While 178 among them were diagnosed with pathology and the others were diagnosed clinically. Results Of all the patients, 108 were diagnosed pheochromocytoma, including 89 131^I-MIBG scan positive and 19 negative. The sensitivity, specificity and accuracy of 131^I-MIBG were 82.41%, 100% and 95.70%, respectively. 131^I-MIBG scan detected 90.00% of unilateral adrenal, 45.45% of bilateral adrenal, 85.71% of ectopic and 66.67 % of malignant lesions, respectively. The proportion of patients with positive 131^I-MIBG scan increased from 20.69 % in all patients to 35.15 % in patients with clinical symptoms and positive conventional imaging （at least one of B-ultrasonography, CT or MR was positive） and 64.58% in those with clinical symptoms, positive conventional imaging, and elevated 24 h urinary catacholamines. In 59 patients with adrenal incidentaloma, 8 were scan-positive and all had confirmed pheochromocytoma, while 2 of scan-negative patients also had confirmed pheochromocytoma. Conclusion 131^I-MIBG scintigraphy is the first choice for the diagnosis of both adrenal and extra-adrenal pheochromocytoma. However, it is inappropriate to take this method as the initial screening approach.