99mTc-3PRGD2 SPECT/CT显像联合增强CT评估肺部肿瘤淋巴结转移的诊断价值:基于41例患者的前瞻性临床试验

  目的  探讨99mTc-3PRGD2 SPECT/CT显像结合增强CT评估胸部肿块淋巴结转移的诊断价值。  方法  前瞻性招募41位患有可疑肺部病变的受试者，分别行99mTc-3PRGD2 SPECT/CT显像和增强CT影像学检查，并行肿瘤切除及淋巴结清扫术，记录上述各项检查对肺部肿瘤淋巴结转移检出情况，以患者手术病理检查或随访情况作为确诊依据。病理结果为“金标准”，分析99mTc-3PRGD2显像、肺部增强CT及二者联合判断肺部恶性肿瘤淋巴结是否转移的诊断能力，分析其敏感度、特异性、准确度、阳性预测值及阴性预测值。  结果  99mTc-3PRGD2显像、增强CT及二者联合诊断肺部肿瘤淋巴结转移的敏感度、特异性、准确度、阳性预测值、阴性预测值分别为54.6%（6/11）、68.4%（13/19）、63.3%（19/30）、50.0%（6/12）、72.2%（13/18），72.3%（8/11）、47.4%（9/19）、56.7%（17/30）、44.4%（8/18）、75.0%（9/12）和81.8%（9/11）、89.5%（17/19）、86.7%（26/30）、81.8%（9/11）、89.5%（17/19）。99mTc-3PRGD2显像的诊断能力相对增强CT的特异性高，敏感度低。两种方法联合诊断胸部的恶性肿瘤淋巴结转移的诊断效能预测指标均高于单独应用增强CT（χ2=6.914，P=0.009）和99mTc-3PRGD2显像（χ2=7.751，P=0.005）。Kappa检验显示99mTc-3PRGD2 SPECT/CT显像、增强CT和二者联合诊断与病理结果的一致性分别为0.225、0.177、0.713（P>0.05），差异无统计学意义。  结论  胸部增强CT联合99mTc-3PRGD2 SPECT/CT显像对于诊断肺部肿瘤淋巴结的转移有很高的准确性，有助于患者的手术决策。 

99mTc-3PRGD2 SPECT/CT imaging combined with enhanced CT to evaluate the diagnostic value of lung tumor lymph node metastasis

  Objective  To investigate the diagnostic value of 99mTc-3PRGD2 SPECT/CT imaging combined with enhanced CT for the evaluation of lymph node metastasis in chest masses.  Methods  Forty-one patients with suspected lung lesions were prospectively recruited and underwent 99mTc-3PRGD2 SPECT/CT imaging and enhanced CT imaging with tumor resection and lymph node dissection. The detection of lymph node metastasis in lung tumors was recorded. The pathological results were used as the "gold standard" to analyze the diagnostic ability of 99mTc-3PRGD2 imaging, lung-enhanced CT and the combination of both to determine whether lymph node metastasis of lung malignant tumors were detected. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were measured.  Results  The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 99mTc-3PRGD2 imaging, enhanced CT, and the combination of the two for the diagnosis of lymph node metastasis in lung tumors were 54.6% (6/11), 68.4% (13/19), 63.3% (19/30), 50.0% (6/12), 72.2% (13/18); 72.3% (8/11), 47.4% (9/19), 56.7% (17/30), 44.4% (8/18), 75.0% (9/12); 81.8% (9/11), 89.5% (17/19), 86.7% (26/30), 81.8% (9/11), 89.5% (17/19). The diagnostic power of 99mTc-3PRGD2 imaging relative to enhanced CT ability was relatively high in specificity and low in sensitivity compared to enhanced CT. The diagnostic efficacy of both methods was higher than that of enhanced CT (χ2=6.914, P=0.009) and 99mTc-3PRGD2 imaging (χ2=7.751, P=0.005) alone for the diagnosis of malignant lymph node metastasis in the chest. The concordance of diagnostic and pathological findings using Kappa test comparing 99mTc-3PRGD2 SPECT/CT imaging, enhanced CT and both combined were 0.225, 0.177, 0.713, respectively, which were not statistically different (P>0.05).  Conclusion  Chest-enhanced CT combined with 99mTc-3PRGD2 SPECT/CT imaging has high accuracy in diagnosing lymph node metastasis of lung tumors and helps patients' surgical decision.