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99Tcm-MIBI-SPECT与定位CT同机融合显像对肺部肿物的鉴别诊断价值

刘长江1,董燕玉2,鞠智卿2,张立广2,李斌2   

  1. 1. 兴义市人民医院，承德医学院附属医院
    2. 承德医学院附属医院
  • 收稿日期:2011-12-14 修回日期:2012-03-29 出版日期:2012-09-15 发布日期:2012-09-15
  • 通讯作者: 董燕玉

Differential diagnosis of lung masses with integrated 99Tcm-MIBI-SPECT/CT

  • Received:2011-12-14 Revised:2012-03-29 Published:2012-09-15 Online:2012-09-15

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摘要： 目的：探讨99Tcm-MIBI-SPECT与定位CT同机融合显像对肺部肿物的鉴别诊断价值。方法：对2008年12月~2011年9月34例可疑恶性肺部肿物患者进行前瞻性研究，所有受检者均于注射99Tcm-MIBI前吸氧，注射后10min、2h分别进行早期和延迟SPECT与定位CT断层同机融合显像。对良、恶性肺部病灶摄取比值（早期：EUR, 延迟：DUR）应用独立样本t检验统计分析，并分别对EUR、DUR的诊断效率进行受试者工作特征曲线分析。结果：34例肺部肿物患者，27例为恶性肺部病灶，7例良性肺部病灶。99Tcm-MIBI-SPECT与定位CT同机融合显像定性分析对肺部肿物良恶性鉴别诊断灵敏度100%、特异性71.43%、准确性94.12%、阳性预测值93.10%、阴性预测值100%。恶性肺部病灶EUR为3.29±2.10[95%可信区间(CI)：2.46，4.12]，良性肺部病灶为1.55±0.66（95%CI：0.94，2.16），两者差异有统计学意义（t=2.14，P＜0.05）。恶性肺部病灶DUR为3.40±2.05（95%CI：2.59，4.21），良性肺部病灶为1.59±0.61（95%CI：1.02，2.15），两者差异有统计学意义（t=2.28，P＜0.05）。半定量ROC分析显示：以EUR≥1.87为界值，灵敏度92.60%，特异性71.40%。以DUR≥1.78为界值，灵敏度100%，特异性71.40%。结论： 99Tcm-MIBI-SPECT与定位CT同机融合显像对肺部肿物的良恶性鉴别具有较高的临床应用价值，是中小城市中低收入肺部肿物患者较为实用的早期鉴别诊断方法。

关键词: 99Tcm-MIBI, SPECT, CT, 融合显像, 肺部病灶, 肺癌

Abstract: Objective: To investigate the differential diagnostic value of integrated 99Tcm-MIBI-SPECT/CT after oxygen inhalation for lung masses. Methods: From December 2008 to September 2011, we had prospectively studied 34 consecutive patients with lung masses. All patients breathed oxygen via nasal catheter before 99Tcm-MIBI injection. Ten minutes and 2 hours after 99Tcm-MIBI injection, early and delayed SPECT/CT fusion imaging of the chest was performed, respectively. The uptake ratios of malignant and benign lung masses were compared by independent-samples T test. In addition, the diagnostic efficiency of uptake ratios of lung masses was analyzed with receiver operating characteristic (ROC) curve. Results: There were 27 patients with malignant lung lesions and 7 patients with benign lung lesions. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of qualitative analysis were 100%, 71.43%、94.12%, 93.10% and 100%, respectively. In patients with malignant lung lesions, the early mean T/N ratio value ± standard deviation was 3.29±2.10. Whereas in patients with benign lung lesions, that was 1.55±0.66. In patients with malignant lung lesions, the delayed mean T/N ratio value ± standard deviation was 3.40±2.05. Whereas in patients with benign lung lesions, that was 1.59±0.61. The early and delayed T/N ratio were significantly different between malignant lung lesions and benign lung lesions (t=2.14, t=2.28, respectively. P＜0.05). Semiquantitative analysis showed that for a early T/N value ≥1.87, the value of sensitivity and specificity was 92.60% and 71.40%, respectively (ROC curve), for a delayed T/N value ≥1.78, the value of sensitivity and specificity was 100% and 71.40%, respectively (ROC curve). Conclusion: Our study shows that integrated 99Tcm-MIBI-SPECT/CT takes on highly clinical value in differentiating malignant from benign lung masses, and it is a practical method for medium-to-low income patients with lung masses in small and medium-sized cities.

Key words: Technetium Tc 99m Sestamibi, SPECT, X-Ray Computed Tomography, Fusion imaging, Lung lesion, lung cancer