吸氧99Tcm-MIBI SPECT与定位CT结合对肺部病灶的鉴别诊断价值

目的 探讨吸氧99Tcm-甲氧基异丁基异腈（MIBI）SPECT与定位CT结合对肺部病灶的鉴别诊断价值，为肺部病灶的良恶性鉴别建立一种高性价比方法。方法对2008年9月至2009年3月47例可疑恶性肺部病灶患者进行前瞻性研究，对疑似炎性反应病例短期应用抗生素。所有受检者于注射99TcmMIBI前开始经鼻腔导管吸氧，注射后10min进行SPECT与CT定位融合显像，2h后进行延迟显像。对良、恶性肺部病灶（T）与对侧相应肺组织（N）的摄取比值（早期：EUR，延迟：DUR）比较应用独立样本t检验，并对EUR和DUR的诊断效率进行受试者工作特征（ROC）曲线分析。结果47例患者（32例原发性肺癌，4例肺转移，11例良性病变）共51个肺部病灶，恶性病灶39个，良性病灶12个。99TcmMIBISPECT与定位CT融合显像诊断肺部良恶性病灶的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为94．9％（37／39）、83．3％（10／12）、92．2％（47／51）、94．9％（37／39）和83．3％（10／12）。恶性病灶EUR为2．95±1．16[95％可信区间（CI）：2．57～3．32）]，良性病灶EUR为1．43±0．33（95％CI：1．22～1．64），两者差异有统计学意义（t=-4．44，P〈0．01）；恶性病灶DUR为3．19±1．74（95％CI：2．62—3．75），良性病灶DUR为1．60±0．32（95％CI：1．39—1．81），两者差异有统计学意义（t=-3．12，P〈0．01）。半定量ROC分析显示：以EUR≥1．625为诊断肺部恶性病灶的界值，灵敏度97．4％（38／39），特异性83．3％（10／12）；以DUR≥1．75为诊断肺部恶性病灶的界值，灵敏度94．9％（37／39），特异性83．3％（10／12）。结论吸氧99TcmMIBISPECT与定位CT结合显像对肺部病灶的良恶性鉴别具有较高的临床价值。

The differentiatial diagnostic value of 99Tcm-MIBI SPECT combined with localizable CT imaging in oxygen intervention for lung lesions

Objective To investigate the differentiatial diagnostic value of 99Tcm-methoxyisobutylisonitrile ( MIBI ) SPECT combined with localizable CT in the evaluation of oxygen intervention for suspicious lung lesions,and to establish a cost-effective imaging modality in the detection of malignant lung lesions.Methods From September 2008 to March 2009,47 consecutive patients with suspicious malignant lung lesions underwent 99Tcm-MIBI SPECT/CT prospectively. Patients with suspicious pneumonia were treated with antibiotics for about 4 d before imaging. All patients were cannulized with a nostril tube for oxygen inhalation before 99Tc-MIBI injection. SPECT combined with localizable CT of the chest was performed at 10 min and 2 h after 99Tcm-MIBI injection. The uptake ratios of lesion to contralateral normal lung parenchyma(early uptake ratio:EUR and delayed uptake ratio:DUR) were compared using independent-samples ttest. In addition,the diagnostic efficiency of uptake ratios of lung lesions was analyzed with receiver operating characteristic (ROC) curve. Results Forty-seven patients ( primary lung cancers:32,metastatic tumors of the lung:4,benign lung diseases:11 ) had 51 lung lesions,including 39 malignant and 12 benign lung lesions. The sensitivity,specificity,accuracy,positive predictive value (PPV),and negative predictive value (NPV) were 94.9% (37/39),83.3% ( 10/12),92.2% (47/51),94.9% (37/39) and 83.3% ( 10/12),respectively. The EUR of malignant lesions was 2.95 ± 1.16,whereas of benign lesions was 1.43 ±0.33. The DUR of the malignant lesions was 3.19 ± 1.74,whereas of benign lesions was 1.60 ±0.32. Both EUR and DUR were significantly different between malignant and benign lung lesions,respectively (t= -4.44,-3.12,respectively,both P＜0.01). The ROC curve showed that EUR value ≥1.625 provided the sensitivity of 97.4% (38/39) and specificity of 83.3% (10/12); DUR value ≥ 1.75provided the sensitivity of 94.9% (37/39) and specificity of 83.3% (10/12). Conclusion 99Tcm-MIBI SPECT combined with localizable CT imaging in oxygen intervention has a potential value in differentiating malignant from benign lung lesions.