^(99m)Tc-MIBI显像对甲状腺癌术后复发、颈淋巴结转移的定性诊断价值

Diagnostic Value of^(99m)Tc-MIBI Imaging in Search of Recrudesced Focuses and Metastasized Lymph Nodes from Neck of Surgical Patients with Thyroid Cancer

为探讨99m锝 甲氧基异丁基异腈 ( 99mTc MIBI)显像对颈部肿块的鉴别诊断价值 ,对对照组 17例 ,甲状腺癌术后组 2 3例 ,甲状腺腺瘤组 2 1例 ,甲状腺癌未手术组 3例 ,不明原发灶的颈部恶性肿瘤组 2例 ,行99mTc MIBI显像 ,共检测肿块 64个 ,5 3个与病理对照。结果显示 :观察法诊断良、恶性肿块的灵敏度为 90 .3 % ,特异度为78.8% ,正确指数 0 .70 ;甲状腺癌术后组 12个良性肿块无假阳性 ,仅 3个小于 0 .5cm淋巴转移灶未检出 ,甲状腺瘤 7个肿块假阳性。RI值法灵敏度 5 8.1% ,特异度 5 4 .5 % ,正确指数 0 .13。研究表明 :观察法优于RI值法 :99mTc MIBI显像对颈部肿瘤具有一定的定性诊断价值 ,尤其是对明确的甲状腺癌术后病例 ,甲状腺内复发肿块或颈部肿大的淋巴结99mTcO4-显像未显示 ,而99mTc MIBI显像阳性者应高度警惕恶性病变。

To evaluate the discriminating between benign and malignant nodules with 99m Tc MIBI imaging,17 controls, 23 cases of surgical thyroid cancer,21 cases of thyroid adenoma, 3 cases of thyroid cancer without operation before imaging and 2 cases of neck malignant tumor of unknown primary position were examined by 99m Tc MIBI imaging ,64 nodules were examined and 53 nodules were compared with the pathologic findings. The results showed that the sensitivity is 90.3%, the specificity is 78.8% by the method of eye observing.Youden's Index is 0.70 .12 benign nodules of surgical thyroid cancer were not false positive, only 3 metastasized lymph nodes with their diametetr less than 0.5 cm were not found out. 7 nodules of thyroid adenoma were false positive .By the method of RI value ,the Sensitivity is 58.1%, the Specificity is 54.5%,Youden's Index is 0.13 . The study indicated that the method of eye observing is better than RI value, and the recrudesced nodules in thyroid or tumefied lymph nodes in the neck should be highly suspected of malignancy when they didn't display with 99m TcO 4 - imaging but displayed with 99m Tc MIBI imaging ,especially for surgical patients with specific thyroid cancer.