^131ISPECT／CT用于^131I平面显像不能定性摄碘灶的临床价值

The value of ^131I SPECT/CT in differentiating indeterminate ^131I uptake on planar whole body scan

目的探讨^131ISPECT／CT对^131I全身平面显像（WBS）不能确定性质的摄碘灶的鉴别诊断价值。方法DTC患者56例，男19例，女37例，年龄20～85（45±15）岁。于^131I治疗后第5天行^131IWBS，对^131IWBS不确定的摄碘灶进行^131ISPECT／CT显像。采用四格表，检验对比分析2种显像的差异。结果”。IWBS共显示摄碘灶288处，其中不能明确诊断的摄碘灶108处（37．5％）。经^131ISPECT／CT显像后，108处中27处摄碘灶被明确诊断为DTC转移灶（25．O％），71处被确定为非DTC转移灶（65．7％），分别为鼻、口腔、唾液腺、上颌窦囊肿、残留甲状腺组织、胸腺、胆囊炎、胃肠道、子宫、体表污染等非特异性摄取；其余10处^131ISPECT／CT也不能明确定性（9．3％）。与^131IWBS相比，^131ISPECT／CT提高了对DTC转移灶和非转移灶的鉴别能力（X2=102．35，P〈0．01）。结论对DTC患者^131IWBS难以判别的摄碘灶，^131ISPECT／CT可提高临床鉴别诊断率。

Objective To evaluate the clinical value of ^131I SPECT/CT in the differentiation of indeterminate ^131I uptake on planer whole body scan （WBS） for patients with DTC after ^131I treatment. Methods Fifty-six DTC patients （ male ： 19, female ： 37, mean age ： 45 ＋ 15 years, ranging from 20 to 85 years） underwent ^131I treatment. 131I WBS was performed five days after 131I treatment, followed by regional ^131I SPECT/CT for the indeterminate foci with abnormal uptake on ^131I WBS. The diagnostic difference of the two imaging modalities was compared by X2 test. Results There were 288 loci with abnormal uptake on ^131I WBS, including 108 indeterminate loci （37.5%）. Subsequent^131ISPECT/CT identified 27 foci as DTC metastases （25.0%） and 71 foci as non-metastases such as benign lesions at nose, oral cavity, salivary gland, maxillary cyst, thyroid remnant, thymus, gallbladder, gastrointestinal tract, and uterus, or non-specific uptake of body contaminations （65.7%）. However, the remaining 10 foci （9.3%） remained indeterminate on ^131I SPECT/CT imaging. The diagnostic accuracy of 131I SPECT/CT was significantly higher than that of 1311 WBS （ X 2 = 102.35, P 〈 0.01 ）. Conclusion ^131I SPECT/CT could significantly improve the diagnostic accuracy for the differentiation of indeterminate foci with abnormal uptake on ^131I WBS.