治疗活度^(131)I SPECT/CT显像对分化型甲状腺癌患者诊断增益价值的研究

Value of post-therapeutic of^(131)I SPECT/CT imaging in diagnosing patients with differentiated thyroid carcinoma

目的探讨治疗活度^(131)I SPECT/CT显像对分化型甲状腺癌(DTC)患者的诊断增益价值和其对临床诊疗决策的影响。方法回顾性分析2017年1月至2020年5月于四川大学华西医院接受^(131)I治疗的404例DTC患者的临床资料,其中男性89例、女性315例,年龄21~69(46.3±5.9)岁。所有患者均首次行^(131)I治疗,剂量为1.11~9.25 GBq,治疗后第5天行全身前、后位^(131)I平面显像,同时对其探测到的摄碘灶加做SPECT/CT显像,单独依据^(131)I平面显像和SPECT/CT显像将摄碘灶定性为残甲、颈部淋巴结转移、远处转移和不确定性病灶。依据CT的解剖定位信息,计算SPECT/CT显像对^(131)I平面显像显示的摄碘灶的原始诊断的修正比例,从而评估SPECT/CT显像对DTC患者临床诊疗决策的影响。^(131)I平面显像与SPECT/CT显像之间的分布差异采用McNemar和McNemar-Bowker检验进行评估。结果404例DTC患者的^(131)I平面显像共检测出927个摄碘灶。SPECT/CT显像对^(131)I平面显像显示的927个摄碘灶中的179个摄碘灶具有诊断增益价值,准确解释了^(131)I平面显像不能定性的118个摄碘灶。SPECT/CT显像对11.9%(48/404)的DTC患者具有诊断增益价值,1.7%(7/404)患者的诊疗决策发生了改变。^(131)I平面显像与SPECT/CT显像结果在摄碘灶定性诊断中的差异有统计学意义(χ2=101.69,P<0.001),SPECT/CT显像对颈部淋巴结转移灶的显示明显优于^(131)I平面显像(McNemar检验,P<0.05)。结论治疗活度^(131)I SPECT/CT显像对DTC患者具有诊断增益价值,并对其临床诊疗决策具有积极意义。

Objective To investigate the diagnostic gain value and its effect on clinical diagnosis and treatment of post-therapeutic^(131)I SPECT/CT imagings in patients with differentiated thyroid carcinoma(DTC).Methods This retrospective study enrolled 404 DTC patients composed of 89 males and 315 females and aged 21 to 69(46.3±5.9)years old.The patients took their first^(131)I therapy at the West China Hospital of Sichuan University between January 2017 and May 2020.All patients were evaluated using SPECT/CT imagings and whole-body anteroposterior position^(131)I planar scans five days after receiving a dose of 1.11–9.25 GBq.The^(131)I planar scans and the SPECT/CT imagings were evaluated independently for iodine uptake foci,which were categorized as residual thyroid,lymph node,distant metastasis and the equivocal foci.According to the anatomical location information of CT,the correction ratio of SPECT/CT imagings to the original diagnosis of iodine uptake foci shown by^(131)I planar scans was calculated.Then,the influence of SPECT/CT imagings on the clinical diagnosis and management of DTC patients was further assessed.McNemar test and McNemar–Bowker test were both used to assess the distribution differences between^(131)I planar scans and SPECT/CT imagings.Results A total of 927 iodine uptake foci were detected in the^(131)I planar scans of 404 DTC patients.According to the images of^(131)I planar scans,SPECT/CT imagings led to a revision of the original diagnosis in 179 of 927 iodine uptake foci,and 118 iodine uptake foci considered to be indeterminate based solely on the planar images were accurately classified.SPECT/CT imagings has diagnostic gain value for 11.9%(48/404)of DTC patients,and 1.7%(7/404)patients'diagnosis and treatment decisions have changed.The difference between^(131)I planar scans and SPECT/CT imagings in the qualitative diagnosis of iodine uptake foci was statistically significant(χ2=101.69,P<0.001).Regarding the detection of metastatic cervical lymph nodes,the characterization of the^(131)I uptake by SPECT/CT was significantly better than that by planar scans(McNemar test,P<0.05).Conclusion Post-therapeutic^(131)I SPECT/CT imagings is of positive significance in the diagnostic gain value and diagnosis and treatment of patients with DTC.