99Tc^(m)O_(4)^(-)甲状腺显像诊断残甲的影响因素及24h摄碘率预测其阳性的分析

An Analysis of Influencing Factors of 99Tc^(m)O_(4)^(-)Thyroid Scan in the Diagnosisof Remnant Thyroid Tissue and 24h Thyroid RadioactiveIodine Uptake on Its Positive Prediction

目的分析99Tc^(m)O_(4)^(-)甲状腺显像诊断残甲的影响因素及甲状腺24h摄碘率预测其阳性的价值。方法回顾性分析2020年1月至2022年12月间在宿迁市第一人民医院核医学科行首次131 I治疗的164例DTC患者(男52例,女112例;年龄23~76岁)的临床资料。患者分为131 I治疗前99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性组(114例)和阴性组(50例)。以口服治疗剂量131 I 72h后的131 I-SPECT/CT断层融合显像作为“金标准”,分析99Tc^(m)O_(4)^(-)甲状腺显像灵敏度、特异性、准确度、阳性预测值、阴性预测值。对可能影响99Tc^(m)O_(4)^(-)甲状腺显像残甲的因素采用单因素分析。建立甲状腺24h摄碘率值预测99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的受试者工作特征(ROC)曲线。结果99Tc^(m)O_(4)^(-)甲状腺显像残甲灵敏度为70.44%(112/159),特异性为60.00%(3/5),准确度为70.12%(115/164),阳性预测值为98.24%(112/114),阴性预测值为3.75%(3/50)。两组间患者的性别及血清TSH水平是影响99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的因素(χ2=10.416,Z=2.78,均P<0.05),而两组间年龄、血清sTg及sTgAb水平差异无统计学意义(Z值:0.738、1.470和0.909,均P>0.05)。此外,99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性组24h摄碘率明显高于阴性组,差异有统计学意义(Z=7.607,P<0.05),24h摄碘率预测99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的ROC曲线下面积为0.873,最佳阈值为1.05%,95%CI为0.818~0.928,其预测99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的灵敏度、特异性分别为74.6%、90.0%。结论99Tc^(m)O_(4)^(-)甲状腺显像评估分化型甲状腺癌术后残甲临床应用价值较高;患者的性别、血清TSH水平是影响99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的独立影响因素;24h摄碘率高于1.05%时,其预示99Tc^(m)O_(4)^(-)甲状腺显像残甲阳性的概率较高。

Objective To analyze influence factors of 99Tc^(m)O_(4)^(-)thyroid scan in the diagnosis of remnant thyroid tissue and the value of 24h thyroid iodine uptake(RAIU)in its positive prediction.Methods A retrospective analysis was performed on 164 DTC patients(52 males and 112 females,23-76 years old)who received 131 I treatment for the first time in the Department of Nuclear Medicine of the First People’s Hospital of Suqian City from January,2020 to December,2022.These patients were divided into a 131 I pre-treatment 99Tc^(m)O_(4)^(-)thyroid imaging positive group(114 cases)and a negative group(50 cases).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 99Tc^(m)O_(4)^(-)thyroid imaging were calculated using 131 I-SPECT/CT fusion imaging 72 hours after the oral therapeutic dose of 131 I as the“gold standard”.Factors that could affect 99Tc^(m)O_(4)^(-)thyroid imaging were identified by single factor analysis.The receiver operating characteristic curve(ROC)of 24h RAIU was drawn to evaluate the positive prediction performance of 99Tc^(m)O_(4)^(-)thyroid residual nail.Results The remnant thyroid sensitivity of 99Tc^(m)O_(4)^(-)thyroid imaging was 70.44%(112/159),along with the specificity of 60.00%(3/5),the accuracy of 70.12%(115/164),the positive predictive value of 98.24%(112/114)and the negative predictive value of 3.75%(3/50).Gender and serum TSH level of patients between the two groups were both factors affecting 99Tc^(m)O_(4)^(-)thyroid scan remnant positive(χ2=10.416,Z=2.78,all P<0.05),while there was no statistical significance for age,serum sTg and sTgAb levels between the two groups(Z value:0.738,1.470 and 0.909,all P>0.05).In addition,the 24h RAIU in the positive group of 99Tc^(m)O_(4)^(-)thyroid scan remnant was significantly higher than that in the negative group(Z=7.607,P<0.05).The area under ROC curve for the prediction of the 24h RAIU for positive 99Tc^(m)O_(4)^(-)thyroid thyroid imaging was 0.873,and the optimal threshold was 1.05%(95%CI 0.818-0.928),with the sensitivity and specificity of 99Tc^(m)O_(4)^(-)remnant thyroid positive of 74.6%and 90%,respectively.Conclusion 99Tc^(m)O_(4)^(-)thyroid scan has a high clinical value in the evaluation of remnant thyroid after the operation of differentiated thyroid carcinoma.Gender and the serum TSH level of patients are the independent influencing factors of positive remnant thyroid of 99Tc^(m)O_(4)^(-)thyroid imaging.When the 24h RAIU is higher than 1.05%,there is a higher probability of positive remnant thyroid of 99Tc^(m)O_(4)^(-)thyroid scan.