治疗活度131I SPECT/CT显像对分化型甲状腺癌患者诊断增益价值的研究

目的 探讨治疗活度131I SPECT/CT显像对分化型甲状腺癌（DTC）患者的诊断增益价值和其对临床诊疗决策的影响。 方法 回顾性分析2017年1月至2020年5月于四川大学华西医院接受131I治疗的404例DTC患者的临床资料，其中男性89例、女性315例，年龄21~69（46.3 ± 5.9）岁。所有患者均首次行131I治疗，剂量为1.11~9.25 GBq，治疗后第5天行全身前、后位131I平面显像，同时对其探测到的摄碘灶加做SPECT/CT显像，单独依据131I平面显像和SPECT/CT显像将摄碘灶定性为残甲、颈部淋巴结转移、远处转移和不确定性病灶。依据CT的解剖定位信息，计算SPECT/CT显像对131I平面显像显示的摄碘灶的原始诊断的修正比例，从而评估SPECT/CT显像对DTC患者临床诊疗决策的影响。131I平面显像与SPECT/CT显像之间的分布差异采用McNemar和McNemar-Bowker检验进行评估。 结果 404例DTC患者的131I平面显像共检测出927个摄碘灶。SPECT/CT显像对131I平面显像显示的927个摄碘灶中的179个摄碘灶具有诊断增益价值，准确解释了131I平面显像不能定性的118个摄碘灶。SPECT/CT显像对11.9%（48/404）的DTC患者具有诊断增益价值，1.7%（7/404）患者的诊疗决策发生了改变。131I平面显像与SPECT/CT显像结果在摄碘灶定性诊断中的差异有统计学意义（χ2=101.69，P<0.001），SPECT/CT显像对颈部淋巴结转移灶的显示明显优于131I平面显像（McNemar检验，P<0.05）。 结论 治疗活度131I SPECT/CT显像对DTC患者具有诊断增益价值，并对其临床诊疗决策具有积极意义。

Value of post-therapeutic of 131 I SPECT/CT imaging in diagnosing patients with differentiated thyroid carcinoma

Objective To investigate the diagnostic gain value and its effect on clinical diagnosis and treatment of post-therapeutic 131I SPECT/CT imagings in patients with differentiated thyroid carcinoma (DTC). Methods This retrospective study enrolled 404 DTC patients composed of 89 males and 315 females and aged 21 to 69 (46.3±5.9) years old. The patients took their first 131I therapy at the West China Hospital of Sichuan University between January 2017 and May 2020. All patients were evaluated using SPECT/CT imagings and whole-body anteroposterior position 131I planar scans five days after receiving a dose of 1.11–9.25 GBq. The 131I planar scans and the SPECT/CT imagings were evaluated independently for iodine uptake foci, which were categorized as residual thyroid, lymph node, distant metastasis and the equivocal foci. According to the anatomical location information of CT, the correction ratio of SPECT/CT imagings to the original diagnosis of iodine uptake foci shown by 131I planar scans was calculated. Then, the influence of SPECT/CT imagings on the clinical diagnosis and management of DTC patients was further assessed. McNemar test and McNemar–Bowker test were both used to assess the distribution differences between 131I planar scans and SPECT/CT imagings. Results A total of 927 iodine uptake foci were detected in the 131I planar scans of 404 DTC patients. According to the images of 131I planar scans, SPECT/CT imagings led to a revision of the original diagnosis in 179 of 927 iodine uptake foci, and 118 iodine uptake foci considered to be indeterminate based solely on the planar images were accurately classified. SPECT/CT imagings has diagnostic gain value for 11.9% (48/404) of DTC patients, and 1.7% (7/404) patients' diagnosis and treatment decisions have changed. The difference between 131I planar scans and SPECT/CT imagings in the qualitative diagnosis of iodine uptake foci was statistically significant (χ2=101.69, P<0.001). Regarding the detection of metastatic cervical lymph nodes, the characterization of the 131I uptake by SPECT/CT was significantly better than that by planar scans (McNemar test, P<0.05). Conclusion Post-therapeutic 131I SPECT/CT imagings is of positive significance in the diagnostic gain value and diagnosis and treatment of patients with DTC.