^(99)Tc^m-3PRGD_2 SPECT/CT在肺部良恶性病变中的诊断价值

Diagnostic value of ^(99)Tc^m-3PRGD_2 SPECT/CT in benign and malignant lung lesions

目的探讨^(99)Tc^m-3PRGD_2 SPECT/CT对肺部良恶性病变的诊断价值。方法回顾性分析于治疗前行^(99)Tc^m-3PRGD_2平面显像、胸部SPECT/CT显像,并最终获得病理结果的37例肺部病变患者资料,其中恶性病变27例,良性病变10例。将肺部病变对99 Tcm-3PRGD2的摄取灰度与肝脏对比,分为低度增高、中度增高、高度增高;计算病变(L)最高摄取值与对侧正常肺(N)、肝脏(H)、纵隔(Me)、对侧三角肌(Mu)平均摄取值的比值,并进行统计学分析,评价其诊断效能;选取肺良恶性病变各1例行免疫组织化学分析整合素αvβ3表达。结果 37例患者肺部病变对^(99)Tc^m-3PRGD_2摄取均增高,66.67%(18/27)恶性病变高度增高,90.00%(9/10)良性病变轻、中度增高;恶性肺部病变摄取比值均高于良性病变(P均<0.05),以L/N=5.45或L/Mu=4.65为阈值,诊断肺恶性病变的敏感度、特异度和准确率均为77.80%、80.00%、78.40%;免疫组化结果显示肺恶性病变高表达整合素αvβ3,良性病变仅少量表达。结论 ^(99)Tc^m-3PRGD_2 SPECT/CT对肺部良恶性病变的鉴别具有诊断价值。

Objective To investigate the value of 99Tcm-3PRGD2 SPECT/CT imaging in the diagnosis of benign and ma- lignant lung lesions. Methods A retrospective analysis of 99Tcm-3PRGD2 planar imaging and chest SPECT/CT imaging with lung lesions before treatment was performed. Totally 37 cases including 27 malignant and 10 benign lesions confirmed pathologiclly were enrolled. Compared with hepar in planar imaging, the intake gray scale of 99 Tcm -3PRGD2 in lung lesions was divided into low, moderate, and high elevations. The ratio of the highest intake value of the lesion （L） to the contra- lateral normal lung （N）, the hepar （H）, the mediastinum （Me） and the contralateral deltoid muscle （Mu） was calculated, and statistical analysis was performed to evaluate the diagnostic efficacy. The expression of immunohistochemistry integrin av133 was performed through selecting 1 case of benign and malignant lung lesions, respectively. Results The intake of 99Tcm-3PRGD2 was higher in 37 patients with lung lesions. High elevation of malignant lesion was 66. 67% （18/27） , low and moderate elevation of benign lesion was 90.00% （9/10）. The intake ratio of malignant lung lesions was higher than that of benign lesions （all P〈0.05）. When L/N was greater than 5.45 or L/Mu was greater than 4.65, the sensitivity, specificity and accuracy of diagnosis of lung malignant lesions was 77.80%, 80.00% and 78.40%, respectively. Immuno- histochemical results showed that malignant lung lesions highly expressed integrin αvβ3, and only a small number of benign lesions expressed it. Conclusion 99Tcm-3PRGD2 SPECT/CT is valuable in the differential diagnosis of benign and malig- nant lung lesions.