^(99)Tc^m-MIBI SPECT与定位CT同机融合显像对肺部病灶的鉴别诊断价值

The differential diagnostic value of ^(99)Tc^m-MIBI SPECT/CT fusion imaging for lung lesions

目的:探讨99Tcm-MIBI SPECT与定位CT同机融合显像对肺部病灶的鉴别诊断价值,为肺部病灶的良恶性鉴别建立一种高性价比方法。方法:对2008年12月—2011年6月45例可疑恶性肺部病灶患者进行前瞻性研究。所有受检者均于注射后10 min、2 h分别进行早期和延迟SPECT/CT断层同机融合显像。对良、恶性肺部病灶摄取比值(早期:EUR,延迟:DUR)应用独立样本t检验统计分析,并分别对EUR、DUR的诊断效率进行受试者工作特征(ROC)曲线分析。结果:30例原发性肺癌,15例良性肺部病灶。99Tcm-MIBI SPECT与定位CT同机融合显像定性分析对肺部单发病灶诊断灵敏度96.7%、特异性73.3%、准确性88.9%、阳性预测值87.9%、阴性预测值91.7%。恶性肺部病灶EUR为2.80±2.21(95%CI:1.97,3.62),良性肺部病灶为1.56±0.71(95%CI:1.17,1.95),两者差异有统计学意义(t=-2.10,P=0.041)。恶性肺部病灶DUR为2.93±1.86(95%CI:2.24,3.63),良性肺部病灶为1.64±0.81(95%CI:1.20,2.09),两者差异有统计学意义(t=-2.56,P=0.014)。半定量ROC分析显示:以早期摄取比≥1.50为界值,对应灵敏度96.7%,特异性73.3%。以延迟摄取比≥1.459为界值,灵敏度100%,特异性66.7%。结论 :99Tcm-MIBISPECT与定位CT同机融合显像对肺部病灶的良恶性鉴别具有较高的临床应用价值,是中小城市中低收入肺部病灶患者较为实用的早期鉴别诊断方法。

Objective： To investigate the differential diagnostic value of 99Tcm-MIBI SPECT/CT fusion imaging for lung le- sions, and to establish a cost-effective imaging modal in the detection of malignant lung lesions. Methods： From December 2008 to May 2011, we had prospectively studied 45 consecutive patients with suspicious malignant lung lesions. Ten minutes and 2 hours after 99Tcm-MIBI injection, early and delayed SPECT/CT fusion imaging of the chest were performed respectively. The uptake ratios of malignant and benign lung lesions were compared by independent-samples T test. In addition, the diag- nostic efficiency was analyzed with receiver operating characteristic （ROC） curve. Results： There are 30 patients with primary lung cancers and 15 patients with benign lung lesions. The sensitivity, specificity, accuracy, positive predictive value（PPV）, and negative predictive value （NPV） of qualitative analysis were 96.7%, 73.3%, 88.9% 87.9% and 91.7% respectively. In patients with malignant lesions, the early mean T/N ratio value＋standard deviation 2.80±2.21 （95%CI： 1.97, 3.62）, whereas in patients with benign lesions was 1.56±0.71 （95%CI： 1.17, 1.95）. In patients with malignant lesions, the delayed mean T/N ratio value＋ standard deviation was 2.93±1.86 （95%CI： 2.24, 3.63）, whereas in patients with benign lesions was 1.64±0.81 （95%CI： 1.20, 2.09）. The T/N ratio had significant difference between malignant lung lesion and benign lung lesion（t=-2.10, t=-2.56, respec- tively. P〈0.05）. Semiquantitative analysis showed that for an early T/N value≥ 1.50, the value of sensitivity and specificity was 96.7% and 73.3%, respectively（ROC curve）, for a delayed T/N value≥1.459, the value of sensitivity and specificity was 100% and 66.7%, respectively（ROC curve）. Conclusion： Our study shows that 99Tcm-MIBI SPECT/CT fusion imaging has highly clinical value in differentiating malignant from benign lung lesions, and is a practical method for medium-to-low income patients with lung lesions in small and medium-sized cities.