^99mTcO4^-/^99mTc-MIBI联合显像对甲状腺癌的诊断价值

Diagnosis value of ^(99m)TcO_4^-/^(99m)Tc-MIBI combined with imaging in thyroid carcinoma

目的:比较99mTcO4-/99mTc-甲氧基异丁基异腈(99mTcO4-/99mTc-MIBI)联合显像与颈部彩色多普勒超声(CDU)检查在甲状腺癌、术后甲状腺癌复发或颈部转移中的诊断结果,探讨99mTcO4-/99mTc-MIBI联合显像在甲状腺癌诊断中的价值。方法:选择经手术治疗甲状腺占位患者150例以及甲状腺癌术后疑似复发或颈部转移而行二次手术患者21例。以术后病理结果为金标准,分别对99mTcO4-/99mTc-MIBI联合显像、颈部CDU检查在437个甲状腺占位、215个直径大于1cm的甲状腺占位以及87个疑似甲状腺癌术后复发或颈部转移中的诊断结果进行对比分析。结果:在甲状腺癌的诊断中CDU检查灵敏度(89.10%)高于99mTcO4-/99mTc-MIBI联合显像(81.99%);CDU与99mTcO4-/99mTc-MIBI联合显像的病理符合率分别为84.67%和80.78%,差异无显著性(P>0.05)。在直径大于1cm甲状腺癌的诊断中99mTcO4-/99mTc-MIBI联合显像灵敏度(97.75%)高于CDU检查(89.89%);CDU与99mTcO4-/99mTc-MIBI联合显像的病理符合率分别为84.65%和87.44%,差异无显著性(P>0.05)。在术后甲状腺癌复发或颈部转移灶的诊断中颈部CDU检查灵敏度、特异性(44.78%,40.00%)均低于99mTcO4-/99mTc-MIBI联合显像(64.18%,80.00%);CDU与99mTcO4-/99mTc-MIBI联合显像的病理符合率分别为43.68%和67.82%,差异有显著性(P<0.05)。结论:99mTcO4-/99mTc-MIBI联合显像对直径较大的甲状腺癌诊断较灵敏,尤其是在诊断术后甲状腺癌复发或颈部转移方面优势明显。

Objective To identify the diagnosis value of 99mTcO-4/99mTc-MIBI combined with imaging in thyroid carcinoma by comparing the diagnostic results of 99mTcO-4/99mTc-MIBI combined with imaging and neck color Doppler ultrasonography（CDU）in thyroid carcinoma,postoperative recurrence or cervical part metastasis.Methods 150 patients with thyroid carcinoma treated by operation and 21 patients who were carried out the second operation because of the suspicion of postoperative recurrence or cervical part metastasis were selected.The pathological results were used as the gold standard and the diagnostic values of 99mTcO-4/99mTc-MIBI combined with imaging and neck CDU in analyzing 437 cases of thyroid carcinoma,215 cases of thyroid carcinoma which diameter was greater than 1 cm and 87 cases of suspected postoperative recurrence or cervical part metastasis were compared respectively.Results In the diagnosis of thyroid carcinoma,the sensitivity of CDU（89.10%）was higher than that of 99mTcO-4/99mTc-MIBI combined with imaging（81.99%）;the patho-coincidences of CDU and 99mTcO-4/99mTc-MIBI combined with imaging were 84.67% and 80.78%,respectively,there was no significant difference（P〉0.05）.In the diagnosis of thyroid carcinoma which diameter was greater than 1 cm,the sensitivity of 99mTcO-4/99mTc-MIBI combined with imaging（97.75%）was higher than that of CDU（89.89%）;the patho-coincidences of CDU and 99mTcO-4/99mTc-MIBI combined with imaging were 84.65% and 87.44%,respectively,there was no significant difference（P〉0.05）.In the diagnosis of suspected postoperative recurrence or cervical part metastasis,the sensitivity and specificity of CDU（44.78%,40.00%）were lower than those of 99mTcO-4/99mTc-MIBI combined with imaging（64.18%,80.00%）,the patho-coincidences of CDU and 99mTcO-4/99mTc-MIBI combined with imaging were 43.68% and 67.82%,respectively,there was significant difference（P〈0.05）.Conclusion 99mTcO-4/99mTc-MIBI combined with imaging is more sensitive in large diameter thyroid carcinoma,especially has obvious advantage in diagnosing postoperative recurrence or cervical part metastasis.