SPECT/CT断层显像在分化型甲状腺癌转移灶诊断中的应用价值

Application value of SPECT/CT fusion imaging to the diagnosis of differentiated thyroid carcinoma

目的评价SPECT/CT断层融合显像在分化型甲状腺癌（differentiated thyroid carcinoma,DTC）转移灶定位、定性诊断中的价值。方法行甲状腺全切或次全切除术后DTC患者431例,术后口服^131I 3.70-7.40GBq治疗5d后,行^131I全身平面显像（131I planar whole-body scan,^131I WBS）和SPECT/CT断层融合显像检查,分析2种方法在DTC转移灶定位、定性诊断上的差异,并与临床随访结果进行对比。结果临床随访证实431例患者转移灶共708处;^131I WBS诊断转移灶的灵敏度为86.0%（609/708）,定位、定性准确性为81.8%（579/708）;SPECT/CT诊断转移灶的诊断灵敏度为95.1%（673/708）,定位、定性准确性为92.7%（656/708）,差异有统计学意义（P〈0.01）;68例患者SPECT/CT融合显像发现异常病灶多于^131I WBS检查,59例因此改变治疗方案。结论 SPECT/CT断层融合显像分辨率高,在提高DTC转移灶诊断准确性、减少假阳性、假阴性及调整治疗方案上有重要价值。

Objective To assess the clinical value of SPECT/CT fusion imaging to the localization and qualitative diagnosis of differentiated thyroid carcinoma（DTC）.Methods A total of 431 patients with DTC received total or subtotal thyroidectomy.Post-therapeutic 131 I planar whole-body scan（Rx-WBS）and SPECT/CT fusion imaging were performed 5days after oral administration of therapeutic doses of 3.70 to 7.40 GBq 131 I in all DTC patients.The differences in the localization and qualitative diagnosis were analyzed between two methods and were compared with the follow-up results.Results The follow-up survey confirmed 708 metastasis focuses in 431 patients.The sensitivity,and localization and qualitative accuracy of 131 I WBS for metastasis were 86.0%（609/708）and 81.8%（579/708）,and those of SPECT/CT were 95.1%（673/708）and 92.7%（656/708）,showing significant differences（P〈0.01）.SPECT/CT imaging found more lesions than planar imaging in 68 patients,therefore 59 patients were changed the treatment plan.Conclusion SPECT/CT fusion imaging has high resolution,and it has important clinical value to improving the diagnostic accuracy of DTC metastases,reducing false positive or false negative results,and adjusting therapy plan.