^99Tc^mN-NOET双时相单光子发射计算机断层成像术鉴别诊断肺部良恶性肿瘤

^99Tc^mN-NOET dual-phase SPECT in differential diagnosis of benign and malignant lung tumors

目的探讨^99Tc^mN-NOET双时相单光子发射计算机断层成像术（SPECT）鉴别诊断肺部良恶性肿瘤的临床价值。方法根据病理结果将61例疑似肺癌患者分为恶性组（51例）和良性组（51例）。61例患者术前1周内行孵^99Tc^mN-NOET SPECT20～30rain（早期）、2h（延迟）显像和CT扫描，所有患者检查前均未经放、化疗和手术治疗，均经病理确诊。分析^99Tc^mN-NOET摄取和排泄情况，与CT比较其鉴别诊断肿瘤的价值。结果恶性组和良性组患者的NOET早期摄取比值（ER）分别为1．25±O．15和1．09±O．11，差异有统计学意义（P〈0．001）；延迟摄取比值（DR）分别为1．40±0．17和1．18±0．21，差异有统计学意义（P〈0．001）；滞留指数（RI）分别为（12．22±6．38）％和（8．34-10．91）％，差异无统计学意义（P〉0．05）。不同TNM分期、病理类型、肿瘤直径、肺部肿块空洞、吸烟史和性别的恶性组患者ER、DR和RI比较，差异均无统计学意义（均P〉0．05）。NOET显像鉴别诊断肺部良恶性肿物的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为94．1％、70．0％、94．1％、70．0％、90．2％，CT检查鉴别诊断肺部良恶性肿物的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为90．2％、80．0％、95．8％、61．5％、88．5％，差异均无统计学意义（均P〉0．05）。结论^99Tc^mN-NOET双时相SPECT可以鉴别诊断肺部良、恶性肿物，诊断效能与CT检查无显著差别。^99Tc^mN-NOET显像的半定量指标（ER、DR和nI）也可用于鉴别诊断肺部良、恶性肿物，且不受肺癌患者的TNM分期、病理类型、肿瘤直径、肺部肿块空洞、吸烟史和性别的影响。

Objective To investigate the value of ^99Tc^mN-NOET dual-phase SPECT in differential diagnosis of benign and malignant lung tumors. Methods CT scan, early （20 to 30 min） and delayed （2 h） imaging of NOET SPECT were performed on 61 patients suspected of lung lesions before operation. The results were compared with the pathological findings. All cases were not treated with radiotherapy, chemotherapy or surgery before checks. Moreover, all patients had pathological diagnosis. To determine the value in differential diagnosis of tumors by analyzing the tumor uptake and excretion of ^99Tc^mN-NOET, and the results were compared with that of CT. Results The value of early T/N ratio （ER） in the malignant （G1） and benign （G2） groups was 1.25 ±0.15 and 1.09 ±0.11 （P〈0.001）, respectively, and delayed T/N ratio （DR） was 1.40 ± 0.17 and 1.18± 0.21 （P 〈 0.001 ）. The retention index （RI） of groups G1 was （12.22 ± 6.38 ）% and group G2 was （8.3 ± 10.91 ）%, with a non-significant difference between them （ P 〉 0.05 ）. The ER, DR and RI of NOET SPECT in the malignant patients were not significantly correlated with TNM staging, pathological types, tumor diameter, cavity in the lung tumor mass, history of smoking, tumor size and patient gender （ P 〉 O. 05 ）. The sensitivity of NOET dual-phase SPECT and CT in the differential diagnosis of benign and malignant lung tumors was 94.1% vs. 90.2% , specificity was 70.0% vs. 80.0% , positive predictive value （PPV） was 94.1% vs. 95.8%, negative predictive value （NPV） was 70. 0% vs. 61.5 %, and accuracy was 90. 2%. vs. 88.5% （P 〉 0.05 for all）. Conclusions 99TemN-NOETdual-phase SPECT could be used in differential diagnosis of benign and malignant lung tumors, with no significant differences compared with the efficacy of CT imaging. The semiquantitative indexes （ ER, DR and RI） of NOET SPECT can also be used in differential diagnosis of benign and malignant lung tumors, and are not significantly correlated with TNM staging, pathological types, tumor diameter, cavity of the lung tumor mass, history of smoking, tumor size and patient gender.