20例孤立性肺结节术前氧介入^(99m)Tc-MIBI SPECT-CT同机融合显像的技术探讨

The lung tumor imaging of ^(99m)Tc-MIBI SPECT-CT fusion imaging in the differential diagnosis of solitary pulmonary nodules before surgery

目的探讨孤立性肺结节(SPN)术前氧介入99mTc-MIBI SPECT-CT同机融合显像对鉴别诊断的意义。方法对本院2008年12月至2011年5月20例SPN患者术前进行前瞻性研究,所有受检者均于注射99mTc-MIBI后10min、2h分别进行早期和延迟SPECT-CT断层同机融合显像。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曲线分析。最终诊断根据组织病理学确定。结果氧介入99mTc-MIBISPECT-CT同机融合显像定性分析对SPN良、恶性鉴别诊断灵敏度为90.0%、特异性为70.0%、准确性为80.0%、阳性预测值为75.0%、阴性预测值为87.5%。恶性肺部病灶EUR为(2.13±0.61)[95%CI:1.69～2.57],良性肺部病灶为(1.38±0.45)(95%CI:1.06～1.71),二者比较差异有统计学意义(t=-3.092,P=0.006)。恶性肺部病灶DUR为(2.40±0.47)(95%CI:2.07～2.74),良性肺部病灶为(1.52±0.87)(95%CI:0.90～2.14),二者比较差异有统计学意义(t=-2.812,P=0.012)。半定量受试者工作特征曲线(ROC)分析显示,以EUR≥1.50为界值,灵敏度为90%,特异性为80%。以DUR≥1.41为界值,灵敏度为100%,特异性为80%。结论氧介入99mTc-MIBI SPECT-CT同机融合显像对SPN的良、恶性鉴别具有一定意义。

Objective To investigate the lung tumor imaging of 99mTc-MIBI SPECT-CT fusion imaging in the differential diagnosis of solitary pulmonary nodules（SPNs） before surgery. Methods From December 2008 to May 2011,we had prospectively studied 20 consecutive patients with SPN before surgery. Ten minutes and 2 hours after 99mTc_MIBI injected, early and delay SPECT-CT fu- sion imaging of the chest was performed, respectively. The uptake ratios of malignant and benign lung lesions were compared by independent-samples T test. In addition,the diagnostic efficiency of uptake ratios of lung lesions was analyzed with receiver operating characteristic curve. The final diagnosis was based on the result of histopathology. Results The sensitivity, specificity, accuracy, positive predictive value（PPV）,and negative predictive value （NPV） of qualitative analysis were 90.0 %, 70.0 %, 80.00%,75.0% and 87.5% ,respectively. In patients with malignant SPNs,the early mean T/N ratio value ± standard deviation was 2.13±0.61, whereas in patie.：ts with benign SPNs was 1. 3810.45. In patients with malignant SPNs,the delay mean T/N ratio value ; standard deviation was 2.40 ± 0.47, whereas in patients with benign lesion was 1.52±0. 87. The T/N ratio was significantly difference between malignant SPNs and benign SPNs（t=- 3. 092, t=- 2. 812 ,respectively. P;0.05）. Semiquantitative analysis showed that for a early T/N value ;1.50,the value of sensitivity and specificity was 90% and 80% ,respectively（ROC curve）,for a delay T/N value ≥1.41 ,the value of sensitivity and specificity was 100V0 and 80% ,respectively（ROC curve）. Conclusion The study shows that 99mTc-MIBI SPECT-CT fusion imaging combined with oxygen intervention takes on highly clinical value in differentiating malignant from benign SPNs,and this is a practical method for medium-to-low income patients with SPNs in small and medium-sized cities.