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

目的:探讨99mTc-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:34例可疑肺部恶性肿物患者,注射99mTc-MIBI后10min、2h分别进行早期和延迟SPECT-CT断层同机融合显像。根据诊断金标准分为恶性(27例)和良性肺部病灶(7例)组,分析诊断效率,比较良、恶性肺部病灶对99mTc-MIBI的早期及延迟摄取比值(EUR、DUR),并分别对EUR、DUR的诊断效率进行受试者工作特征曲线(ROC)分析。结果:99mTc-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%、特异度71.43%、准确性94.12%、阳性预测值93.10%、阴性预测值100%。恶性与良性肺部病灶EUR(3.29±2.10vs1.55±0.66)差异有统计学意义(P<0.05),恶性与良性肺部病灶DUR(3.40±2.05vs1.59±0.61)差异亦有统计学意义(P<0.05)。EUR≥1.87或DUR≥1.78为诊断恶性肺部病灶的最佳切点,对应的灵敏度、特异度分别为92.60%、71.4%和100%、71.4%。结论:99mTc-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,是较适用于中小城市中低收入肺部肿物患者的早期鉴别诊断方法。

Differential Diagnosis of Lung Masses with Integrated 99mTc-MIBI-SPECT/CT

Objective:To investigate the differential diagnostic value of integrated 99mTc-MIBI-SPECT/CT after oxygen inhalation for lung mass.Methods:Thirty-four suspicious malignant lung tumor patients were performed early and delayed SPECT/CT fusion imaging 10 minutes and 2 hours after injection of 99mTc-MIBI.Patients were divided into malignant group(n=27) and benign lung lesion group(n=7) according to the "golden standard".The diagnostic efficacy of qualitative analysis was analyzed using sensitivity,specificity,accuracy,positive predictive value(PPV) and negative predictive value(NPV).The early and delayed uptake ratios(EUR and DUR) of 99mTc-MIBI were compared between malignant and benign lung lesion groups,respectively.In addition,the diagnostic efficiency of uptake ratios of lung mass was analyzed with receiver operating characteristic(ROC) curve.Results:The sensitivity,specificity,accuracy,PPV,and NPV of qualitative analysis of integrated 99mTc-MIBI-SPECT/CT were 100%,71.43%,94.12%,93.10% and 100%,respectively.The EUR of malignant lung lesions was significant higher than that of benign lung lesions(3.29±2.10 vs 1.55±0.66,P < 0.05),and the DUR was also significantly higher in malignant lung lesions than that of benign lung lesions(3.40±2.05 vs 1.59±0.61,P < 0.05).ROC curve showed that the EUR value of 99mTc-MIBI ≥ 1.87 provided the sensitivity of 92.60% and specificity of 71.40%,and the DUR value of 99mTc-MIBI ≥1.78 provided the sensitivity of 100% and specificity of 71.40%.Conclusion:Results suggested that integrated 99mTc-MIBI-SPECT/CT showed high clinical value in differentiating malignant from benign lung mass,which was a practical method for medium-to-low income patients with lung mass in small and medium-sized cities.