99Tcm-MIBI SPECT/CT及18F-FDG SPECT/CT对孤立性肺结节的诊断效能比较

目的比较99Tcm-MIBI SPECT/CT及18F-FDG 符合线路SPECT/CT两种显像方法对孤立性肺结节的诊断效能，为中低收入患者寻找更为经济有效的检查方式。方法回顾性分析经18F-FDG 符合线路SPECT/CT显像36例和经99Tcm-MIBI SPECT/CT显像52例，共88例孤立性肺结节患者。根据病理或随访（>2年）结果将其分为恶性组和良性组。比较良恶性病灶组间差异、并采用ROC曲线评价不同本底鉴别诊断良恶性病灶效能。病灶大小和病理学分级与L/N比值关系采用Spearman进行相关性分析。结果18F-FDG 符合线路SPECT/CT显像及99Tcm-MIBI SPECT/CT显像的良恶性组L/N比值ROC曲线下面积分别为0.92、0.88，差异无统计学意义（P=0.565）。所对应的灵敏度及特异度分别为76.92%（20/26）、100%（10/10）和80.77%（21/26），88.46%（23/26）。病灶直径≤2 cm的孤立性肺结节经18F-FDG 符合线路SPECT/CT显像及99Tcm-MIBI SPECT/CT显像的L/N比值曲线下面积分别为1.00及0.90（P=0.746），2 cm

Diagnostic efficacy of 99Tcm-MIBI SPECT/CT and 18F-FDG coincidence SPECT/CT for solitary pulmonary nodules:a comparative study

Objective To compare the diagnostic accuracy of 9 Tcm-MIBI SPECT/CT and 18F-FDG coincidence SPECT/CT for solitary pulmonary nodules. Methods A total of 88 cases suspected of solitary pulmonary nodules were analyzed retrospectively, of whom 36 were examined with 18F-FDG coincidence SPECT/CT and 52 with 9 Tcm-MIBI SPECT/CT. The nature of the solitary pulmonary nodules (malignant or benign) were determined according to the pathological or follow-up (>2 years) results. The diagnostic accuracy of the two modalities for solitary pulmonary nodules was evaluated by ROC curve. The correlation of the lesion size and pathological grade determined by the two modalities with the L/N ratio was assessed using Spearman correlation analysis. Results 18F-FDG coincidence SPECT/CT and 9 Tcm-MIBI SPECT/CT showed a similar area under curve (AUC) of the L/N ratio (0.92 vs 0.88, P=0.565) with diagnostic sensitivities of 76.92% (20/26) and 80.77% (21/26) and specificities of 100%(10/10) and 88.46%(23/26), respectively. For solitary pulmonary nodules with lesion diameter≤2 cm, the AUC was 1.00 with 18F-FDG coincidence SPECT/CT and 0.90 with 9 Tcm-MIBI SPECT/CT (P=0.746), while for nodules beyond 2 cm but below 3 cm, the AUCs were 0.79 and 0.89, respectively (P<0.001). In either of the two modalities, correlation analysis revealed no correlation of the L/N ratio with the pathological grade of the malignant lesions (P=0.771 and 0.077, respectively). The L/N ratio was not correlated with the size of the malignant lesion detected by 9 Tcm-MIBI SPECT/CT (P=0.516) but was significantly correlated with the size of the malignant lesions detected by 18F-FDG coincidence SPECT/CT (P=0.016). Conclusion 9 Tcm-MIBI SPECT/CT has a greater diagnostic accuracy than 18F-FDG coincidence SPECT/CT for solitary pulmonary nodules with lesion a diameter beyond 2 cm, and is therefore the primary choice for low-income patients.