(99m)TcO4-与(99m)Tc-MIBI显像联合彩色多普勒超声评分法对甲状腺结节良恶性的诊断价值

Value of ^(99m)TcO_4^- and ^(99m)Tc-MIBI imaging with ultrasound scoring method in diagnosis of thyroid nodules

背景与目的:目前,彩色多普勒超声评分和核素显像是诊断甲状腺结节的两种重要影像学手段,但是二者检查原理不同,对临床诊断价值孰优,抑或二者联合诊断效果会更好,目前尚无定论。该研究旨在评价^(99m)TcO_4-与^(99m)Tc-甲氧基异丁基异腈(methoxyisobutylisonitrile,MIBI)显像联合彩色多普勒超声评分法对甲状腺结节良恶性的诊断价值。方法:对50例甲状腺结节患者共54个结节作回顾性研究,患者均已行常规彩色多普勒超声检查及^(99m)TcO_4-与^(99m)Tc-MIBI显像,以手术病理检查结果为"金标准",比较^(99m)TcO_4-与^(99m)Tc-MIBI显像联合常规彩色多普勒超声评分法鉴别甲状腺结节良恶性的诊断灵敏度、特异度、准确度、阳性预测值及阴性预测值。结果:^(99m)TcO_4-与^(99m)Tc-MIBI显像诊断甲状腺结节的灵敏度、特异度、准确度、阳性预测值及阴性预测值分别为80.00%(16/20个)、70.59%(24/34个)、74.07%(40/54个)、61.54%(16/26个)、85.71%(24/28个),常规彩色多普勒超声评分法为80.00%(16/20个)、88.24%(30/34个)、85.16%(46/54个)、80.00%(16/20个)、88.24%(30/34个),两种影像学方法结合诊断为100.00%(20/20个)、64.71%(22/34个)、77.78%(42/54个)、62.50%(20/32个)、100.00%(22/22个)。两种影像学方法结合诊断灵敏度高于单独超声评分法或单独核医学检查(100.00%与80.0%、100.00%与80.00%,χ~2=4.444 4、4.444 4,P=0.035 0、0.035 0),单独超声评分法诊断特异度高于两种影像学方法结合(88.24%与64.71%,χ2=5.230 8,P=0.022 2),但两种影像学方法结合诊断无一例假阴性。结论:^(99m)TcO_4-与^(99m)Tc-MIBI显像联合彩色多普勒超声评分法可以从结构和功能两方面更灵敏、更全面地评价甲状腺结节良恶性,以免漏诊。

Background and purpose： At present, color Doppler ultrasound scoring and radionuclide imaging are two important imaging methods for diagnosing thyroid nodules, but their checking principle is different. Which method is better？ Or combining them will be the best method for diagnosing thyroid nodules？ This study aimed to compare the value of 99＇nTcO4- combined with 99mTc-methoxyisobutylisonitrile （MIBI） imaging, ultrasound scoring method and ultrasound scoring method＋99M TeO4-＋99mTc-MIBI imaging in diagnosis of thyroid nodules. Methods： The results of ultrasound scoring method and 99mTcO4 combined with 99MTc-MIBI imaging were compared in 50 patients with 54 thyroid nodules, and then compared with pathological findings. The sensitivity, specificity, accuracy, positive predictive value （PPV） and negative predictive value （NPV） of the methods were calculated. Results： A total of 54 thyroid nodules were found pathologically including 20 malignant and 34 benign nodules. The sensitivity, specificity, accuracy, PPV and NPV of 99mTcO4- combined with 99MTc-MIBI imaging were 80,00% （16/20）, 70.59% （24/34）, 74.07% （40/54）, 61.54% （16/26）, 85.71% （24/28）, respectively. Those of ultrasound scoring method were 80.00% （16/20）, 88.24% （30/34）, 85.16% （46/54）, 80.00% （16/20）, 88.24% （30/34）, respectively. And those of ultrasound scoring method＋99mTcO4-＋99mTc-MIBI imaging were 100.00% （20/20）, 64.71% （22/34）, 77.78% （42/54）, 62.50% （20/32）, 100.00% （22/22）, respectively. The sensitivity of ultrasound scoring method＋99MTcO4-＋99mTc-MIBI imaging was higher than ultrasound scoring method or 99mTcO4- ＋99mTc-MIBI imaging along （100.00% vs 80.00%, 100.00% vs 80.00%, Z2 value was 4.444 4 and 4.444 4, P value was 0.035 0 and 0.035 0, respectively）. The specificity of ultrasound scoring method was higher than those of two methods combined together （88.24% vs 64.71%, Z2 value was 5.2308, P value was 0.022 2）. However, no factorial negative thyroid nodule was found by ultrasound scoring method＋99mTcO4 ＋99Fc -MIBI imaging. Conclusion： Ultrasound scoring method＋99mTcO4-＋99mTc-MIBI imaging can offer comprehensive diagnosis of thyroid nodules from their structure and function to avoid missed diagnosis.