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目的:研究n 99Tcn m-二乙撑三胺五乙酸(DTPA)SPECT/CT眼眶显像中最大标准摄取值(SUVn max)评估甲状腺相关性眼病(TAO)患者眼外肌炎性反应活动度的可行性及价值。n 方法:回顾性纳入2019年7月至2020年4月就诊于大连医科大学附属第二医院的TAO患者38例[男13例、女25例，年龄15~77(48.8±13.7)岁]，根据临床活动度评分(CAS)标准，将38例患者的76只眼分为活动期组(46只眼)、非活动期组(30只眼)。另设对照组，为同期11名健康志愿者[男2名、女9名，年龄20~87(53.5±20.2)岁]，共22只眼。所有受试者行n 99Tcn m-DTPA SPECT/CT眼眶显像，由3名医师测受试眼眼外肌SUVn max及显像剂摄取率(UR)，取平均值；SUVn max经校正后得到校正SUVn max。校正SUVn max、UR的组间差异比较采用Kruskal-Wallis秩和检验及Bonferroni法；采用Spearman秩相关分析校正SUVn max、UR与CAS的相关性；绘制受试者工作特征(ROC)曲线评价校正SUVn max和UR的诊断效能；采用组内相关系数(ICC)进行信度分析，评估校正SUVn max、UR在3名测量者间的一致性。n 结果:活动期组、非活动期组及对照组眼外肌校正SUVn max[15.96(10.99，19.63)、7.98(6.80，9.28)、7.59(6.59，8.20)]、UR[2.17(1.65，2.79)、1.22(1.03，1.39)、1.12(0.99，1.36)]差异均有统计学意义(n H值：42.196、40.642,均n P<0.001)，其中活动期组校正SUVn max和UR均高于非活动期组(标准n H值：-4.971和-5.053，调整后均n P<0.001)及对照组(标准n H值：-5.681和-5.436，调整后均n P0.05)。校正SUVn max、UR与CAS均呈正相关(n rs值：0.653、0.615，均n P<0.001)。校正SUVn max的ROC曲线下面积为0.851，区分活动期与非活动期的阈值为10.125，灵敏度为80.4%(37/46)，特异性为86.7%(26/30)。UR的ROC曲线下面积为0.845，区分活动期与非活动期的阈值为1.565，灵敏度为80.4%(37/46)，特异性为86.7%(26/30)。校正SUVn max与UR的ICC分别为0.966(95% n CI: 0.953~0.976，n P<0.001)和0.618(95%n CI: 0.436~0.744，n P<0.001)。n 结论:SUVn max可作为评价TAO患者眼外肌炎性反应活动度的指标，且与UR相比可能具有更高的价值。n “,”Objective:To investigate the feasibility of maximum standardized uptake value (SUVn max) of extraocular muscle during n 99Tcn m-diethylene triamine pentaacetic acid (DTPA) orbital SPECT/CT imaging for the clinical diagnosis and evaluation of thyroid associated ophthalmopathy (TAO).n Methods:From July 2019 to April 2020, 38 patients (13 males, 25 females, age: 15-77 (48.8±13.7) years; 76 eyes) diagnosed with TAO and 11 healthy volunteers (2 males, 9 females, age: 20-87 (53.5±20.2) years; 22 eyes) were enrolled retrospectively from the Second Hospital of Dalian Medical University. According to the clinical activity score (CAS), 76 eyes were divided into active group (46 eyes) and inactive group (30 eyes). All subjects underwent n 99Tcn m-DTPA orbital SPECT/CT imaging, then SUVn max and uptake ratio (UR) of extraocular muscles were measured and calculated by 3 nuclear medicine physicians. The corrected SUVn max was obtained after correction. Kruskal-Wallis rank sum test and Bonferroni test were used to compare the differences of corrected SUVn max and UR among the three groups. Spearman rank correlation analysis was used to analyze the correlation between corrected SUVn max /UR and CAS. The receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic efficacy of corrected SUVn max and UR. Intra-class correlation coefficient (ICC) was used for reliability analysis to evaluate the consistency of corrected SUVn max and UR among the 3 measurers.n Results:The corrected SUVn max of the extraocular muscles in the active group, inactive group and control group were 15.96(10.99, 19.63), 7.98(6.80, 9.28), 7.59(6.59, 8.20) respectively (n H=42.196, n P<0.001), and UR were 2.17(1.65, 2.79), 1.22(1.03, 1.39), 1.12(0.99, 1.36) respectively (n H=40.642, n P<0.001). The corrected SUVn max and UR of the extraocular muscles in the active group were significantly higher than those in the inactive group (n H values: -4.971, -5.053, both n P<0.001) and in the control group (n H values: -5.681, -5.436, both n P0.05). Both corrected SUVn max and UR were positively correlated with CAS (n rs values: 0.653, 0.615, both n P<0.001). The area under the ROC curve of corrected SUVn max was 0.851, and the threshold value of corrected SUVn max for distinguishing active and inactive periods was 10.125, with the sensitivity of 80.4%(37/46) and the specificity of 86.7%(26/30). The area under the ROC curve of UR was 0.845, and the threshold value for differentiating active and inactive periods was 1.565, with the sensitivity of 80.4%(37/46) and the specificity of 86.7%(26/30). The ICC of corrected SUVn max and UR were 0.966(95% n CI: 0.953-0.976, n P<0.001) and 0.618(95%n CI: 0.436-0.744, n P<0.001) respectively.n Conclusion:Compared with UR, SUVn max may be a more promising index for estimating disease activity of orbits in patients with TAO.n