SPECT-CT与SPECT对亚急性甲状腺炎诊断的对照研究

目的对照研究亚急性甲状腺炎(SAT)的SPECT-CT与SPECT的表现特点,探讨SPECT-CT融合显像在SAT的诊断方面较单独SPECT的增益价值。方法对87例临床可疑为SAT的初诊患者,静脉注射Na99mTcO4 185 MBq 30 min后行同机SPECT及CT扫描,由3名核医学科医师先分析SPECT平面显像,然后再结合CT分析SPECT-CT融合显像并诊断,诊断分为SAT、非SAT和不能确定。在行SPECT-CT显像的前后1周所有初诊患者完成病史、甲状腺功能及抗体、红细胞沉降率、甲状腺摄131I试验等相关资料的采集。将SPECT及SPECT-CT的诊断结果分别与2008年中国甲状腺疾病诊治指南——甲状腺炎相对照。分别计算SPECT、SPECT-CT融合图像对患者能正确诊断(SAT和非SAT)和不能正确诊断(不能确定和诊断错误)的百分率,并分别计算其诊断与最终诊断的符合率。SPECT-CT和SPECT能否明确诊断的百分率比较采用χ2检验。结果最终60例患者确诊为SAT,27例为非SAT。SPECT正确诊断52例,占59.77%(52/87);不能正确诊断35例,占40.23%(35/87),SAT诊断符合率为68.33%(41/60)。SPECT-CT融合显像正确诊断80例,占91.95%(80/87);不能正确诊断7例,占8.05%(7/87),SAT诊断符合率为95.00%(57/60)。SPECT-CT融合显像的正确诊断率(91.95%)显著高于SPECT(59.77%),两者比较有统计学差异(χ2=24.606,P<0.05);SPECT-CT融合显像的SAT诊断符合率(95.00%)亦明显高于SPECT(68.33%),两者比较有统计学差异(χ2=14.249,P<0.05)。结论 SPECT-CT融合显像在SAT的诊断或在SAT与其他甲状腺疾病的鉴别诊断方面较单独SPECT均有增益价值,可以提供更多信息。

Comparative study of SPECT-CT and SPECT in diagnosis of subacute thyroiditis

Objective To discuss the gain value of SPECT-CT fusion imaging than simple SPECT in diagnosis of subacute thyroiditis （SAT） by comparing their performance characteristics. Methods 87 patients who were suspected as SAT in preliminary diagnosis were separately given SPECT and CT scan after intravenous injection of Na99mTcO4 （185 MBq） for 30 minutes. 3 physicians of nuclear medicine analyzed the SPECT planar imaging, and then analyzed SPECT-CT fusion imaging combined with CT and finally diagnosed. The diagnosis results included SAT, non-SAT and cannot be determined. Related data （disease history, thyroid function and antibodies, erythrocyte sedimentation rate, 131I thyroid uptake test, etc.） of all the patients were collected around the week of SPECT-CT imaging. Diagnosis results of SPECT and SPECT-CT were respectively compared with the definition of thyroiditis from the Chinese guidelines of diagnosis and treatment of thyroid disease in 2008. Correct diagnosis percentage （SAT and non-SAT） and incorrect diagnosis percentage （not sure and diagnostic error） by SPECT and SPECT-CT fusion images were respectively calculated. And the coincidence rates of these diagnoses with the final diagnoses were also calculated respectively. Chi-square test was used to compare the diagnosis percentages of SPECT-CT and SPECT. Results Finally, 60 patients were diagnosed as SAT, 27 cases of non-SAT. The diagnostic coincidence rate of SPECT-CT for SAT was 95.00%（57/60）, significantly higher than that of SPECT（68.33%, 41/60）. Difference in the diagnostic coincidence rate of SAT between SPECT-CT and SPECT was statistically significant （χ2=14.249, P〈0.05）. The diagnostic accuracy rate of SPECT-CT was 91.95%（80/87）, much higher than that of SPECT （59.77%, 52/87） （χ2=24.606, P〈0.05）. The uncertain and incorrect diagnostic rates of SPECT-CT and SPECT were 8.05% and 40.23%, respectively. Conclusion Compared with SPECT, the diagnostic accuracy of SPECT-CT was significantly improved. The SPECT-CT f