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

Differential Diagnosis of Lung Masses with Integrated ^(99m)Tc-MIBI-SPECT/CT

目的:探讨99mTc-MIBI-SPECT与定位CT同机融合显像对肺部肿物的鉴别诊断价值。方法:34例可疑肺部恶性肿物患者,注射99mTc-MIBI后10min、2h分别进行早期和延迟SPECT-CT断层同机融合显像。根据诊断金标准分为恶性(27例)和良性肺部病灶(7例)组,分析诊断效率,比较良、恶性肺部病灶对99mTc-MIBI的早期及延迟摄取比值(EUR、DUR),并分别对EUR、DUR的诊断效率进行受试者工作特征曲线(ROC)分析。结果:99mTc-MIBI-SPECT与定位CT同机融合显像定性分析对肺部肿物良恶性鉴别诊断灵敏度100%、特异度71.43%、准确性94.12%、阳性预测值93.10%、阴性预测值100%。恶性与良性肺部病灶EUR(3.29±2.10vs1.55±0.66)差异有统计学意义(P<0.05),恶性与良性肺部病灶DUR(3.40±2.05vs1.59±0.61)差异亦有统计学意义(P<0.05)。EUR≥1.87或DUR≥1.78为诊断恶性肺部病灶的最佳切点,对应的灵敏度、特异度分别为92.60%、71.4%和100%、71.4%。结论:99mTc-MIBI-SPECT与定位CT同机融合显像对肺部肿物的良恶性鉴别具有较高的临床应用价值,是较适用于中小城市中低收入肺部肿物患者的早期鉴别诊断方法。

Objective： To investigate the differential diagnostic value of integrated ^（99m）Tc-MIBI-SPECT/CT after oxygen inhalation for lung mass. Methods： Thirty-four suspicious malignant lung tumor patients were performed early and delayed SPECT/CT fusion imaging 10 minutes and 2 hours after injection of ^（99m）Tc-MIBI： Patients wdre divided into malignant group （n=27） and benign lung lesion group （n=7） according to the ＂golden standard＂. The diagnostic efficacy of qualitative analysis was analyzed using sensitivity, specificity, accuracy, positive predictive value （PPV） and negative predictive value （NPV）. The early and delayed uptake ratios （EUR and DUR） of ^（99m）Tc-MIBI were compared between malignant and benign lung lesion groups, respectively. Irt addition, the diagnostic efficiency of uptake ratios of lung mass was analyzed with receiver operating characteristic （ROC） curve. Results： The sensitivity, specificity, accuracy, PPV, and NPV of qualitative analysis of integrated ^（99m）Tc-MIBI-SPECT/CT were 100%, 71.43%, 94.12%, 93.10% and 100%, respectively. The EUR of malignant lung lesions was significant higher than that of benign lung lesions （3.29±2.10 vs 1.55±0.66, P 〈 0.05）, and the DUR was also significantly higher in malignant lung lesions than that of benign lung lesions （3.40±2.05 vs 1.59±0.61, P 〈 0.05）. ROC curve showed that the EUR value of ^（99m）Tc-MIBI ≥1.87 provided the sensitivity of 92.60% and specificity of 71.40%, and the DUR value of ^（99m）Tc-MIBI≥1.78 provided the sensitivity of 100% and specificity of 71.40%. Conclusion： Results suggested that integrated ^（99m）Tc-MIBI-SPECT/CT showed high clinical value in differentiating malignant from benign lung mass, which was a practical method for medium-to-low income patients with lung mass in small and medium-sized cities.