^(99m)Tc-甲氧异腈显像在分化型甲状腺癌转移灶诊断中的临床应用

The clinical application of ^(99m)Tc-MIBI imaging to diagnosis metastatic lesions of differentiated thyroid carcinoma

目的:探讨^(99m)Tc-甲氧异腈(MIBI)显像在分化型甲状腺癌(DTC)转移灶诊断中的临床应用价值。方法:72例接受131I治疗的分化型甲状腺癌随访患者,以甲状腺球蛋白增高阈值>10ng/ml为标准分为实验组(n=35)和对照组(n=37),常规行131I全身扫描(WBS),同时以^(99m)Tc-MIBI作为显像剂行核素肿瘤显像。以核素显像感兴趣区(ROI)技术,测定放射性(T/NT)比值,进行半定量分析;比较^(99m)Tc-MIBI显像及131I全身显像在诊断甲状腺癌转移灶灵敏性、特异性、准确性上的差异。结果:实验组,^(99m)Tc-MIBI显像和131I全身显像T/NT比值分别为3.24±0.43和5.35±0.32,有明显差异;对照组T/NT比值分别为1.31±0.18和1.26±0.25,无明显差异;两种方法诊断分化型甲状腺癌转移灶的灵敏性、特异性、准确性分别为24.52%、64.28%、32.83%和92.45%、57.14%、85.07%。结论:^(99m)Tc-MIBI显像诊断分化型甲状腺癌转移灶灵敏性及准确性均低于131I全身显像,特异性无明显差异,但99mTc-MIBI显像可作为131I全身显像阴性分化型甲状腺癌随访方法的有益补充。

Objective： To evaluate application value of^99mTc-MIBI imaging in diagnosis of differentiated thyroid carcinoma metastatic lesions.Methods： Seventy-two patients with differentiated thyroid cancer after^131 I nuclear therapy were divided into experiment group and control group depended on Tg（the judgement threshold value is 10ng/ml）.All lesions were confirmed by ^131I-WBS and/or^99mTc-MIBI imaging or by other imaging modalities.The ratio of tumor to normal tissue（T/NT） was calculated over ROI to observe the radioactive uptake.All scintigraphically detected lesions were confirmed by histopathological analysis.Results： The T/NT ratios were 3.24 ± 0.43 and 5.35 ±0.32 in experiment group,respectively,1.31 ± 0.18 and 1.26 ± 0.25 in control group,respectively.The sensitivity,specificity and accuracy in differentiating malignant from benign lesion was 24.52%,64.28%,32.83% and 92.45%,57.14%,85.07%,respectively.Conclusion：^99mTc-MIBI imaging sensitivity,specificity were lower than ^131 I whole body imaging in diagnosis of differentiated thyroid carcinoma metastatic lesions,but^99mTc-MIBI scintigraphy can be used as an effective complement to ^131I-WBS negative of differentiated thyroid cancer conventional methods.