99Tc^(m)-MIBI SPECT/CT肌肉显像诊断痉挛性斜颈张力障碍肌的临床应用

Clinical application of 99Tcm-MIBI SPECT/CT muscle imaging in the diagnosis of dystonic muscle of spasmodic torticollis

目的:探讨 99Tc^(m)-甲氧基异丁基异腈(MIBI) SPECT/CT肌肉显像对颈部肌张力障碍(CD)诊断的潜在临床增益价值。 方法:前瞻性纳入2021年1月至2022年4月间在苏州大学附属第二医院诊治的CD患者50例[男14例、女36例,年龄(45.8±12.5)岁],所有患者在SPECT/CT肌肉显像联合肌电图引导下行肉毒毒素注射治疗。对50例患者的400块颈浅部肌肉(两侧胸锁乳突肌、肩胛提肌、头夹肌、斜方肌各100块)行 99Tc^(m)-MIBI SPECT/CT肌肉显像,以肌电图结果为"金标准"将其分为张力障碍肌组及正常肌组,分别获取肉毒毒素注射治疗前西多伦多痉挛性斜颈评分量表(TWSTRS)评分、颈浅部单块肌肉和颈部总体肌肉的SUV max和靶本比(TBR)、肌电图诊断结果。采用ROC曲线计算SUV max及TBR诊断张力障碍肌的AUC,并用Delong检验比较其差异。2组间SUV max和TBR的比较采用Mann-Whitney U检验,采用Spearman秩相关分析颈部总体肌肉SUV max、TBR与TWSTRS评分的相关性。 结果:张力障碍肌组肌肉205块,正常肌组肌肉195块。CD患者张力障碍肌摄取 99Tc^(m)-MIBI明显增高,且部分张力障碍肌存在非整体性摄取 99Tc^(m)-MIBI增高而表现为整块肌肉摄取不均匀现象。视觉分析判断张力障碍肌的灵敏度、特异性、准确性、阳性预测值及阴性预测值分别为95.12%(195/205)、75.90%(148/195)、85.75%(343/400)、85.58%(195/242)和93.67%(148/158)。张力障碍肌组与正常肌组的SUV max[1.74(1.42,2.12)和0.92(0.81,0.99)]及TBR[2.55(1.92,3.27)和1.44(1.22,1.73)]差异均具有统计学意义( z值:-15.29、-12.69,均 P<0.001)。颈部肌肉SUV max诊断效能优于TBR(AUC:0.942和0.867;z=5.03, P<0.001)。CD患者颈部总体肌肉SUV max、TBR与TWSTRS评分呈正相关( rs值:0.44、0.45,均 P<0.001)。 结论:99Tc^(m)-MIBI SPECT/CT肌肉显像是1种具有较好临床应用价值的诊断CD的影像学方法。

ObjectiveTo explore the potential clinical value of 99Tcm-methoxyisobutylisonitrile(MIBI)SPECT/CT muscle imaging in the diagnosis of cervical dystonia(CD).MethodsFrom January 2021 to April 2022,50 patients with CD(14 males,36 females;age(45.8±12.5)years)who were treated in Second Affiliated Hospital of Soochow University were prospectively included.The 99Tc^(m)-MIBI SPECT/CT muscle imaging results of 400 pieces of muscle(bilateral sternocleidomastoid,musculus scapulae,splenius capitis and musculus trapezius;each of 100 pieces)in 50 patients were analyzed and divided into the dystonic muscle group and normal muscle group according to the electromyography(EMG).Toronto western spasmodic torticollis rating scale(TWSTRS)score,SUVmax and target-to-background ratio(TBR)of single superficial cervical muscle and total cervical muscle,and EMG diagnosis results were obtained before botulinum toxin injection.ROC curves of SUVmax and TBR of dystonic muscles were constructed to determine AUCs and the difference was compared by Delong test.Differences of SUV_(max) and TBR between 2 groups were analyzed by Mann-Whitney U test.Spearman rank correlation analysis was used to analyze the correlation of SUV_(max),TBR and TWSTRS scores of total cervical muscle.ResultsThere were 205 pieces of muscle in dystonic muscle group and 195 pieces of muscle in normal muscle group.The uptake of 99Tc^(m)-MIBI in dystonic muscle was significantly increased in CD patients,and the non-whole uptake of 99Tc^(m)-MIBI was increased in some dystonic muscles,which was manifested as uneven uptake of the whole muscle.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of visual analysis were 95.12%(195/205),75.90%(148/195),85.75%(343/400),85.58%(195/242)and 93.67%(148/158),respectively.There were significant differences of SUV_(max)(1.74(1.42,2.12)vs 0.92(0.81,0.99))and TBR(2.55(1.92,3.27)vs 1.44(1.22,1.73))between the dystonic muscle group and the normal muscle group(z value:-15.29,-12.69,both P<0.001).The diagnostic efficiency of SUV_(max) in dystonic muscle was better than TBR(AUC:0.942 vs 0.867;z=5.03,P<0.001).SUV_(max),TBR and TWSTRS score in the neck muscles of patients with CD showed positive correlation(rs values:0.44,0.45,both P<0.001).Conclusion 99Tc^(m)-MIBI SPECT/CT muscle imaging is a good diagnostic method for dystonic muscle in patients with CD.