胸部薄层CT对99Tc^m-3PRGD2 SPECT/CT显像诊断肺部孤立性占位的增益价值

Incremental value of chest thin layer CT over 99Tc^m-3PRGD2 SPECT/CT imaging in the diagnosis of solitary pulmonary space occupying

目的探讨胸部薄层CT在99Tc^m-联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体{HYNIC-PEG4-E[PEG4-c(RGDfK)]2,简称3PRGD2}显像诊断肺部孤立性占位中的增益价值。方法前瞻性收集2015年7月至2016年12月因肺孤立性占位收住于宁夏医科大学总医院拟行手术治疗的患者共87例,排除其中未获得病理结果者,最终纳入74例[男49例,女25例,年龄37~80(58.4±9.6)岁]。对患者常规行99Tc^m-3PRGD2 SPECT/CT显像,全身平面显像以肿瘤/对侧正常肺组织最大放射性计数比值(T/N)≥1.5、断层显像以T/N≥2.0为阳性标准;显像后1 h行胸部薄层CT检查。以病理结果为"金标准",分析99Tc^m-3PRGD2平面及SPECT/CT显像、胸部薄层CT及三者联合诊断肺孤立性占位良恶性的诊断效能,采用Kappa检验影像学检查结果与病理结果的一致性。结果74例肺占位患者中,手术病理结果示恶性51例,良性23例。99Tc^m-3PRGD2平面显像、SPECT/CT显像、胸部薄层CT诊断肺恶性病变的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为47.1%(24/51)、65.2%(15/23)、52.7%(39/74)、75.0%(24/32)、35.7%(15/42),86.3%(44/51)、47.8%(11/23)、74.3%(55/74)、78.6%(44/56)、11/18和84.3%(43/51)、52.2%(12/23)、74.3%(55/74)、79.6%(43/54)、12/20,三者联合后相应指标分别98.0%(50/51)、73.9%(17/23)、90.5%(67/74)、89.3%(50/56)和17/18。99Tc^m-3PRGD2平面显像、SPECT/CT显像、胸部薄层CT以及三者联合与病理结果的一致性Kappa值分别为0.100、0.250、0.354和0.765(均P<0.001)。结论胸部薄层CT对99Tc^m-3PRGD2 SPECT/CT显像诊断肺孤立性占位的良恶性有增益价值。

Objective To evaluate the additional value of chest thin layer CT over 99Tc^m-hydrazinonicotinyl-(polyethylene glycol)4-E[(polyethylene glycol)4-c(RGDfK)]2(HYNIC-PEG4-E[PEG4-c(RGDfK)]2;3PRGD2)SPECT/CT in detecting isolated pulmonary space.Methods This was a prospective study conducted in General Hospital of Ningxia Medical University.There were 87 patients with solitary pulmonary space occupying between July 2015 and December 2016,and 74 of those patients(49 males,25 females,age range:37-80(58.4±9.6)years)who had pathological results were enrolled.99Tc^m-3PRGD2 SPECT/CT imaging was performed routinely,and then the chest thin layer CT images were acquired.The maximum radioactive counts ratio of tumor to non-tumor(T/N)≥1.5 was the standard for positive planer 99Tc^m-3PRGD2 imaging,and that≥2.0 was the standard for positive SPECT/CT imaging.According to the pathological results as gold standard,the diagnostic efficiencies of 99Tc^m-3PRGD2 planer and SPECT/CT imaging,chest thin layer CT and chest thin layer CT+99Tc^m-3PRGD2 SPECT/CT imaging for malignant pulmonary lesions were calculated.Kappa test was used to compare the consistency of the imaging methods and pathological results.Results The post-surgery histopathology confirmed that 51 patients were with malignancy and 23 had benign lesions.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 99Tc^m-3PRGD2 planer imaging,SPECT/CT imaging and chest thin layer CT in the diagnosis of malignant pulmonary lesions were 47.1%(24/51),65.2%(15/23),52.7%(39/74),75.0%(24/32),35.7%(15/42);86.3%(44/51),47.8%(11/23),74.3%(55/74),78.6%(44/56),11/18 and 84.3%(43/51),52.2%(12/23),74.3%(55/74),79.6%(43/54),12/20,respectively.Those of the chest thin layer CT+SPECT/CT were 98.0%(50/51),73.9%(17/23),90.5%(67/74),89.3%(50/56)and 17/18 respectively.The Kappa values between the imaging methods(99Tc^m-3PRGD2 planer imaging,SPECT/CT imaging,chest thin layer CT and the chest thin layer CT+SPECT/CT)and pathological examination were 0.100,0.250,0.354 and 0.765(all P<0.001).Conclusion Chest thin layer CT has an incremental value over 99Tc^m-3PRGD2 SPECT/CT imaging in the differential diagnosis of benign and malignant pulmonary lesions.