^(99)Tc^(m)-DTPA SPECT/CT眼眶显像眼外肌SUV_(max)在甲状腺相关性眼病活动度评估中的临床应用

Application of SUV_(max)of extraocular muscle on^(99)Tc^(m)-DTPA orbital SPECT/CT for evaluating activity of thyroid associated ophthalmopathy

目的研究99Tcm-二乙撑三胺五乙酸(DTPA)SPECT/CT眼眶显像中最大标准摄取值(SUV_(max))评估甲状腺相关性眼病(TAO)患者眼外肌炎性反应活动度的可行性及价值。方法回顾性纳入2019年7月至2020年4月就诊于大连医科大学附属第二医院的TAO患者38例[男13例、女25例,年龄15~77(48.8±13.7)岁],根据临床活动度评分(CAS)标准,将38例患者的76只眼分为活动期组(46只眼)、非活动期组(30只眼)。另设对照组,为同期11名健康志愿者[男2名、女9名,年龄20~87(53.5±20.2)岁],共22只眼。所有受试者行99Tcm-DTPA SPECT/CT眼眶显像,由3名医师测受试眼眼外肌SUV_(max)及显像剂摄取率(UR),取平均值;SUV_(max)经校正后得到校正SUV_(max)。校正SUV_(max)、UR的组间差异比较采用Kruskal-Wallis秩和检验及Bonferroni法;采用Spearman秩相关分析校正SUV_(max)、UR与CAS的相关性;绘制受试者工作特征(ROC)曲线评价校正SUV_(max)和UR的诊断效能;采用组内相关系数(ICC)进行信度分析,评估校正SUV_(max)、UR在3名测量者间的一致性。结果活动期组、非活动期组及对照组眼外肌校正SUV_(max)[15.96(10.99,19.63)、7.98(6.80,9.28)、7.59(6.59,8.20)]、UR[2.17(1.65,2.79)、1.22(1.03,1.39)、1.12(0.99,1.36)]差异均有统计学意义(H值:42.196、40.642,均P<0.001),其中活动期组校正SUV_(max)和UR均高于非活动期组(标准H值:-4.971和-5.053,调整后均P<0.001)及对照组(标准H值:-5.681和-5.436,调整后均P<0.001),非活动期组与对照组之间差异无统计学意义(标准H值:-1.190和-0.796,调整后均P>0.05)。校正SUV_(max)、UR与CAS均呈正相关(rs值:0.653、0.615,均P<0.001)。校正SUV_(max)的ROC曲线下面积为0.851,区分活动期与非活动期的阈值为10.125,灵敏度为80.4%(37/46),特异性为86.7%(26/30)。UR的ROC曲线下面积为0.845,区分活动期与非活动期的阈值为1.565,灵敏度为80.4%(37/46),特异性为86.7%(26/30)。校正SUV_(max)与UR的ICC分别为0.966(95%CI:0.953~0.976,P<0.001)和0.618(95%CI:0.436~0.744,P<0.001)。结论SUV_(max)可作为评价TAO患者眼外肌炎性反应活动度的指标,且与UR相比可能具有更高的价值。

Objective To investigate the feasibility of maximum standardized uptake value(SUV_(max))of extraocular muscle during^(99)Tc^(m)-diethylene triamine pentaacetic acid(DTPA)orbital SPECT/CT imaging for the clinical diagnosis and evaluation of thyroid associated ophthalmopathy(TAO).Methods From July 2019 to April 2020,38 patients(13 males,25 females,age:15-77(48.8±13.7)years;76 eyes)diagnosed with TAO and 11 healthy volunteers(2 males,9 females,age:20-87(53.5±20.2)years;22 eyes)were enrolled retrospectively from the Second Hospital of Dalian Medical University.According to the clinical activity score(CAS),76 eyes were divided into active group(46 eyes)and inactive group(30 eyes).All subjects underwent^(99)Tc^(m)-DTPA orbital SPECT/CT imaging,then SUV_(max)and uptake ratio(UR)of extraocular muscles were measured and calculated by 3 nuclear medicine physicians.The corrected SUV_(max)was obtained after correction.Kruskal-Wallis rank sum test and Bonferroni test were used to compare the differences of corrected SUV_(max)and UR among the three groups.Spearman rank correlation analysis was used to analyze the correlation between corrected SUV_(max)/UR and CAS.The receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic efficacy of corrected SUV_(max)and UR.Intra-class correlation coefficient(ICC)was used for reliability analysis to evaluate the consistency of corrected SUV_(max)and UR among the 3 measurers.Results The corrected SUV_(max)of the extraocular muscles in the active group,inactive group and control group were 15.96(10.99,19.63),7.98(6.80,9.28),7.59(6.59,8.20)respectively(H=42.196,P<0.001),and UR were 2.17(1.65,2.79),1.22(1.03,1.39),1.12(0.99,1.36)respectively(H=40.642,P<0.001).The corrected SUV_(max)and UR of the extraocular muscles in the active group were significantly higher than those in the inactive group(H values:-4.971,-5.053,both P<0.001)and in the control group(H values:-5.681,-5.436,both P<0.001),while there was no significant difference between the inactive group and the control group(H values:-1.190,-0.796,both P>0.05).Both corrected SUV_(max)and UR were positively correlated with CAS(rs values:0.653,0.615,both P<0.001).The area under the ROC curve of corrected SUV_(max)was 0.851,and the threshold value of corrected SUV_(max)for distinguishing active and inactive periods was 10.125,with the sensitivity of 80.4%(37/46)and the specificity of 86.7%(26/30).The area under the ROC curve of UR was 0.845,and the threshold value for differentiating active and inactive periods was 1.565,with the sensitivity of 80.4%(37/46)and the specificity of 86.7%(26/30).The ICC of corrected SUV_(max)and UR were 0.966(95%CI:0.953-0.976,P<0.001)and 0.618(95%CI:0.436-0.744,P<0.001)respectively.Conclusion Compared with UR,SUV_(max)may be a more promising index for estimating disease activity of orbits in patients with TAO.