99Tcm-tetrofosminSPECT诊断肺部肿瘤的临床价值

Clinical value of 99Tcm-tetrofosmin SPECT in the diagnosis of lung neoplasms

目的探讨99Tcm-tetrofosmin（99Tcm-TF）SPECT亲肿瘤显像诊断肺部肿瘤的临床价值。方法收集在我科进行99Tcm-TF肺亲肿瘤显像的患者41例；所有患者均在治疗前一周行胸部CT检查及99Tcm-TF SPECT肺亲肿瘤显像。对照最终结果，评价两种方法鉴别肺肿瘤病变性质的诊断效能。以肿瘤3cm大小为界，分≥3cm组和〈3cm组，评价99Tcm-TF SPECT显像在两组中的诊断效能。结果99Tcm-TF SPECT肺亲肿瘤显像的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为66．7％、35．7％、56．1％、66．7％和35．7％；CT肺扫描的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为92．6％、50．0％、78．0％、78．1％和77．8％。CT较99Tcm-TF SPECT的灵敏度（x2=5．594，P〈0．05）和准确率（x2=4．473，P〈0．05）高，而特异度两者间的差异无统计学意义,（x2=0．583，P〉0．05）。同时，肿瘤≥3cm和〈3cm组中，99Tcm-TF检查肺肿瘤的灵敏度、特异度、准确率分别为78．9％、25．0％、69．6％和37．5％、40．0％、38．9％，而两组的特异度差异无统计学意义（x2=0．28，P〉0．05），灵敏度（x2=4．352，P〈0．05）和准确率（x2=3．858，P〈0．05）有差异。结论CT对于肺癌诊断有一定的价值，相比而言，99Tcm-TF的诊断价值有限。临床医生在行该项检查之前需经过筛选才有可能提高其临床价值。

Objective To explore the clinical value of 99Tcm-tetrofosmin （99Tcm-TF）in the diagnosing of lung neoplasms. Methods 99Tcm-TF lung affinity tumor imaging data from 41 patients in our department were retrospectively reviewed. Chest computer tomography （CT） and 99Tcm-TF SPECT lung affinity tumor imaging were performed within one week before treatment. Diagnostic efficiency of the two methods in identifying lung neoplasm characteristics were evaluated by comparing final diagnosis results. Cases were grouped into tumor sizes, as follows： not less than 3 cm and less than 3 em with a 3 cm threshold. The diagnostic efficiencies of 99Tcm-TF SPECT imaging of the two groups were compared. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 99Tcm-TF imaging in diagnosing lung neoplasm were 66.7%, 35.7%, 56.1%, 66.7% and 35.7%, respectively, whereas the corresponding values for chest CT scanning were 92.6%, 50.0%, 78.0%, 78.1% and 77.8%. Thus, CT was more sensitive （x2=5.594, P〈0.05 ） and accurate （x2=4.473, P〈0.05 ） than 99Tcm-TF SPECT imaging, but was not specific （x2=0.583, P〉..05 ）. The sensitivity, specificity, and accuracy of 99Tcm-TF imaging for the group with a size of not less than 3 cm were 78.9%, 25.0%, and 69.6%, whereas the corresponding values for the group with less than 3 cm size were 37.5%, 40.0%, and 38.9%, respectively. No significant difference was found in specificity 0（2=0.28, P〉0.05） between the two groups, but sensitivity （x2=4.352, P〈0.05） and accuracy （x2=3.858, P〈0.05） were significantly different between the groups. Conclusions CT was superior in diagnosing lung cancer compared with 99Tcm-TF The value of 99Tcm-TF may be improved when clinical doctors screen the proper patients.