SPECT/CT同机融合显像对分化型甲状腺癌转移灶诊治的增益价值

Added Value of SPECT/CT Fusion Imaging in the Management of Metastatic Differentiated Thyroid Cancer

目的评价分化型甲状腺癌(DTC)治疗剂量的131I-SPECT/CT融合显像对131I全身扫描(WBS)的增益价值。资料与方法57例复发或转移的DTC患者131I治疗后行WBS及131I-SPECT/CT显像,最终诊断以病理、影像检查和临床随访结果为依据。对比两种检查结果,在病灶和患者两种水平上评价SPECT/CT显像DTC定位和定性诊断的增益价值,及其对治疗策略的影响。结果 57例WBS共发现215处放射性摄取病灶,经SPECT/CT融合显像均准确定位,并排除了12例假阳性病灶。融合显像还新发现37处摄碘病灶和45处不摄碘病灶。WBS和SPECT/CT融合显像诊断DTC摄碘转移灶的敏感性分别为80.1%、100.0%;特异性为63.6%、81.8%;准确性为78.1%、97.8%。融合显像对摄碘转移灶的总体检出率较高(χ2=8.50,P<0.05),对摄碘转移灶的诊断价值增加了24.5%(66/269),15例(26.3%)患者的治疗策略获得了改进。结论 131I-SPECT/CT融合显像能更好地对放射性摄取增高灶进行精确定位和定性,对WBS诊断不明确的DTC加做SPECT/CT显像在提高诊断准确率、减少伪影和调整治疗方案上具有重要价值。

Purpose To evaluate the added value of therapeutic dose 131 I SPECT/CT to planar 131 I whole body scan（WBS） in the management of patients with differentiated thyroid cancer（DTC）.Materials and Methods 57 pathology proven DTC patients with relapse or metastasis were examined with post-therapeutic planar 131 I imaging and SPECT/CT.The added value of SPECT/CT was determined on levels of individual focus and each patient,and the change of management was analyzed.Results 215 foci shown on planar 131 I imaging were accurately localized by SPECT/CT,and 12 false positive lesions were excluded.Additional 37 foci of increased uptake and 45 foci without uptake were detected by 131 I SPECT/CT.WBS and 131 I SPECT/CT showed sensitivity of 80.1% and 100.0%,specificity of 63.6% and 81.8%,accuracy of 78.1% and 97.8%,respectively.131 I SPECT/CT was more accurate in detecting metastatic focus than WBS（χ 2 =8.50,P0.05）.In 24.5% of 269（n=66） iodine-avid foci,additional information was provided on 131 I SPECT/CT,of which 15（26.3%） had management modification based on this information.Conclusion Compared with planar whole body imaging,131 I SPECT/CT correctly decides disease classification and location,and it is important to receive SPECT/CT for uncertain DTC by WBS to improve diagnosis,reduce artifact and adjust therapeutic regimen.