99Tcm-3PRGD2 SPECT/CT显像在不摄碘进展性放射性碘难治性分化型甲状腺癌中的诊断价值

目的 评价99Tcm-甲苯磺酸钠烟酰胺腙聚乙二醇双环精氨酸-甘氨酸-天冬氨酸肽（简称99Tcm-3PRGD2） SPECT/CT显像对不摄碘进展性放射性碘难治性分化型甲状腺癌（RAIR-DTC）的诊断效能。 方法 前瞻性选择2019年10月至2022年5月在福建省立医院行99Tcm-3PRGD2 SPECT/CT检查的59例RAIR-DTC患者，其中男性17例、女性42例，中位年龄为51（28，80）岁。所有患者均行99Tcm-3PRGD2 SPECT/CT显像，其中22例接受酪氨酸激酶抑制剂（TKI）治疗，37例接受促甲状腺激素（TSH）抑制治疗（13例在2周内接受了18F-FDG PET/CT显像）。取每例患者最大病灶的最大标准化摄取值（SUVmax）进行分析。采用ROC曲线评估99Tcm-3PRGD2 SPECT/CT显像的诊断效能并计算99Tcm-3PRGD2 SPECT/CT显像检出RAIR-DTC病灶的SUVmax临界值；采用Pearson相关分析法分析病灶长径（TL）、刺激性甲状腺球蛋白（sTg）水平与SUVmax的相关性；采用配对t检验比较分析RAIR-DTC患者TKI治疗前后sTg水平、SUVmax、TL间的关系；采用Spearman分析法分析99Tcm-3PRGD2 SPECT/CT显像与18F-FDG PET/CT显像在检出阳性病灶的SUVmax之间的关系。 结果 59例RAIR-DTC患者的276个病灶被纳入分析，其中TKI治疗前后对比病灶59个。99Tcm-3PRGD2 SPECT/CT显像对RAIR-DTC病灶诊断的灵敏度和特异度分别为94.9% （95%CI：90.7%~97.3%）和88.7%（95%CI：77.5%~95.0%）。ROC曲线结果显示，99Tcm-3PRGD2 SPECT/CT显像检出RAIR-DTC病灶的SUVmax临界值为2.70。Pearson相关分析结果显示，靶病灶的SUVmax与sTg水平、TL均呈正相关（r=0.811、0.635，均P=0.001）。22例患者经TKI治疗后，RAIR-DTC病灶的SUVmax显著降低（t=11.027，P=0.001）。Spearman相关分析结果显示，99Tcm-3PRGD2 SPECT/CT显像与18F-FDG PET/CT显像在检出阳性病灶的SUVmax间呈正相关（r=0.560，P=0.001），且ROC曲线分析结果显示，99Tcm-3PRGD2 SPECT/CT显像对RAIR-DTC病灶的诊断效能与18F-FDG PET/CT显像的差异无统计学意义（Z=0.312，P=0.753）。 结论 99Tcm-3PRGD2 SPECT/CT显像对不摄碘进展性RAIR-DTC的诊断具有较高的灵敏度和特异度，与18F-FDG PET/CT显像相似。

99Tcm-3PRGD2 SPECT/CT imaging in the diagnosis of progressive radioiodine refractory differentiated thyroid cancer without iodine uptake

Objective To evaluate the diagnostic efficiency of 99Tcm-sodium toluene sulfonate nicotinamide hydrazone PEGylated bicyclic arginine-glycine-aspatic acid peptide (abbreviation 99Tcm-3PRGD2) SPECT/CT imaging to progressive radioiodine refractory differentiated thyroid cancer (RAIR-DTC) without iodine uptake. Methods A total of 59 patients with RAIR-DTC who underwent 99Tcm-3PRGD2 SPECT/CT examination in Fujian Provincial Hospital from October 2019 to May 2022 were prospectively selected, including 17 males and 42 females, with a median age of 51 (28, 80) years. All patients underwent 99Tcm-3PRGD2 SPECT/CT, among them, 22 patients were treated with a tyrosine kinase inhibitor (TKI), and 37 patients had thyroid-stimulating hormone (TSH) inhibition [13 patients underwent 18F-fluorodeoxyglucose (FDG) PET/CT within two weeks]. Maximum standardized uptake value (SUVmax) of the lesion with the largest-length diameter in each patient was analyzed. The diagnostic efficiency of 99Tcm-3PRGD2 SPECT/CT imaging was evaluated by receiver operating characteristic (ROC) curves analysis and was also used to calculate the SUVmax cut-off value of 99Tcm-3PRGD2 SPECT/CT to assist in the detection of RAIR-DTC lesions. Using Pearson correlation analysis method to analyze the correlations between the target lesion (TL), stimulated thyroglobulin (sTg) levels and SUVmax. The relationships between the sTg levels, SUVmax and TL in RAIR-DTC patients before and after TKI treatment were analyzed by paired t test. Results A total of 276 lesions from 59 RAIR-DTC patients were included in the analysis. These 59 lesions were compared before and after TKI treatment. The sensitivity and specificity of 99Tcm-3PRGD2 SPECT/CT imaging for the diagnosis of RAIR-DTC lesions were 94.9% (95%CI: 90.7%–97.3%) and 88.7% (95%CI: 77.5%–95.0%), respectively. The ROC curves results showed that the cut-off value of SUVmax for RAIR-DTC lesions detected by 99Tcm-3PRGD2 SPECT/CT imaging was 2.70. The results of the Pearson correlation analysis showed that the SUVmax of the target lesions was positively correlated with the sTg levels and TL (r=0.811, 0.635, both P=0.001). The paired t test results showed that SUVmax in RAIR-DTC lesions was significantly decreased before and after TKI treatment (t=11.027, P=0.001). Spearman correlation analysis showed that there was a positive correlation between 99Tcm-3PRGD2 SPECT/CT imaging and 18F-FDG PET/CT imaging in detecting SUVmax of positive lesions (r=0.560, P=0.001). However, the results of ROC curves analysis did not show statistical significance in the diagnostic efficiency of 99Tcm-3PRGD2 SPECT/CT imaging for RAIR-DTC lesions versus 18F-FDG PET/CT imaging (Z=0.312, P=0.753). Conclusion 99Tcm-3PRGD2 SPECT/CT imaging had high sensitivity and specificity in the diagnosis of progressive RAIR-DTC without iodine uptake, similar to 18F-FDG PET/CT.