^131I SPECT／CT在分化型甲状腺癌诊断中的增益价值

目的评价131ISPECT／CT显像在DTC患者中相对于131I全身显像（WBS）的增益价值。方法回顾性对比分析97例DTC患者[男31例，女66例，平均年龄44．1（17—74）岁]176个摄碘灶的131IWBS和131ISPECT／CT显像资料。显像均为131I治疗后的常规扫描，SPECT／CT显像针对WBS发现的病灶进行。由2位核医学科医师阅片，以病理及随访结果为诊断标准，分析131ISPECT／cT及131IIWBS对摄碘灶定位定性的诊断能力，并应用SPSS13．0对两者诊断准确性进行∥检验。结果131IWBS检出摄碘灶175个（颈部128个，远处灶47个），SPECT／CT检出病灶176个（颈部128个，远处灶48个）。173个病灶经病理及随访确诊，良性78个，恶性95个；3个未定性（仍在随访中）。确诊的摄碘灶中，残留甲状腺组织51个，颈部淋巴结转移或局部残留病灶67个，生理性摄取灶7个，远处转移灶30个，远处生理性摄取灶18个。131IIWBS诊断摄碘灶的灵敏度73．7％（70／95），特异性78．2％（61／78），准确性61．3％（106／173）；其准确性低于131ISPECT／CT（98．8％，171／173；x2=72．3，P〈0．05）。131ISPECT／CT纠正131IWBS误判摄碘灶67个，其中纠正定位错误27个，定性错误40个；颈部37个[占全部颈部灶的28．9％（37／128）]，远处灶30个（62．5％，30／48）。与131IWBS的最初诊断相比，131IISPECT／CT显像改变了27个转移部位的诊断，改变了8例患者临床分期的诊断，并最终改变了14例患者的治疗方案。结论131ISPECT／CT可以弥补131IWBS的不足，更准确区分残余甲状腺组织和淋巴结、肺或骨等远处转移及生理性摄取，对于DTC的诊治有较好的增稀价值。

Improvement of lesion detection in patients with differentiated thyroid carcinoma using 131I SPECT/ CT

Objective To evaluate the incremental value of 131I SPECT/CT over 131I whole body scan （WBS） in the patients with DTC. Methods A total of 97 patients with DTC （31 males, 66 females, mean age： 44.1 years, age range： 17 to 74 years） were retrospectively reviewed. All subjects underwent 131I WBS and SPECT/CT after 131I treatment. The images were interpreted by 2 experienced nuclear medicine physicians. The final diagnosis was based on the pathologic findings and clinical follow-up. The diagnostic ac curacies between 131I WBS and 131I SPECT/CT were compared usingXz test with SPSS 13.0. Results 131I WBS detected 175 lesions （ 128 neck and 47 distant lesions）, while 131I SPECT/CT found 176 lesions （ 128 neck and 48 distant lesions）. Out of the 176 lesions, 78 were confirmed as benign and 95 as malignant, in cluding 51 lesions in thyroid bed, 67 cervical lymph nodes or local residual lesions, 7 lesions related to lo cal physiological uptake, 30 distant metastases and 18 distant loci due to physiological uptake. The other 3 lesions were still in follow-up. The sensitivity and specificity of 131I WBS was 73.7% （70/95） and 78.2% （61/78）, respectively. The accuracy of 1311 WBS （ 106/173,61.3% ） was lower than that of 131I SPECT/CT （171/173,98.8%; X2 =72.3, P〈0.05）. 131I SPECT/CT corrected the diagnosis of 131I WBS in 67 lesions, including 37 local lesions （37/128, 28.9%） and 30 （ 30/48, 62.5%） distant metastases. The sources of error for the 67 lesions were due to wrong location （ n = 27） or wrong characterization （ n = 40）. Compared with 131I WBS, 131I SPECT/CT changed the location in 27 lesions, clinical staging in 8 cases and therapeu tic strateaw in 14 cases. Conclusions 131I SPECT/CT could irnrove the differentiation of malianant locallesions from residual thyroid, of distant metastatic lymph node, lung or bone lesions from physiological up take. Such incremental values would be valuable to the management of DTC patients compared with WBS.