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目的回顾性比较SPECT/CT和全身131I核素显像联合应用与仅行核素显像对于高分化甲状腺癌放射碘治疗后的新增诊断价值。材料与方法本回顾性研究经单位伦理委员会批准,无需签署知情同意书。研究包括2009年10月—2010年8月经放射碘治疗的高分化甲状腺癌病人147例(男53例,女94例,平均年龄51岁)。每例病人均于放射碘治疗的同一天进行全身核素显像和SPECT/CT检查。全身核素显像中的每个放射性浓聚灶,根据甲状腺床内、淋巴结和远隔转移的摄取情况分为阳性和不能确定。采用常规McNemar检验对全身核素显像与SPECT/CT的检查结果进行比较评价。结果 SPECT/CT清晰地确定了甲状腺床内全身核素显像不能确定的全部5个“高摄取”病灶的起源(正常甲状腺残余组织或淋巴结转移)。对于核素显像诊断为转移淋巴结的108个放射性浓聚灶,其中的24个(22.2%)SPECT/CT改变了原来的结论(P<0.0001)。在SPECT/CT检查中,85个全身核素显像阳性的病灶中有1个证实为阴性(假阳性);在20个全身核素显像不能确定的病灶中,13个证实为阳性,7个证实为阴性。SPECT/CT检查还纠正了3个核素显像为假阴性的病灶。对于远隔转移灶,52个病灶中有24个(40%)的诊断结论被SPECT/CT修正(P<0.0001)。在SPECT/CT检查中,32个全身核素显像诊断为阳性的病灶中有1个被证实为阴性;20个全身核素显像不能确定的病灶中,11个证实为阳性,9个证实为阴性。对于全部147例病人,通过SPECT/CT检查改变了9例(6.1%)病人的临床分期和3例(2.0%)病人的治疗方案。结论与全身核素显像相比,SPECT/CT提高了131I在淋巴结转移和远隔转移内浓聚的发现和定位准确性。
Objective To retrospectively compare the new diagnostic value of SPECT / CT combined with whole-body 131I imaging and radionuclide imaging in the treatment of well-differentiated thyroid cancer with radioactive iodine. Materials and Methods This retrospective study was approved by the Ethics Committee of a unit without the need to sign an informed consent form. The study included 147 patients with well-differentiated thyroid cancer treated with radioactive iodine (53 men and 94 women, mean age 51 years) from October 2009 to August 2010. All patients underwent whole body radionuclide imaging and SPECT / CT on the same day as radioiodine therapy. Whole body radionuclide imaging of each radioactive focal stove, according to the thyroid bed, lymph nodes and distant metastases uptake is divided into positive and can not be determined. The conventional McNemar test was used to compare the results of whole body radionuclide imaging and SPECT / CT. Results SPECT / CT clearly identified the origin (normal thyroid remnant tissue or lymph node metastasis) of all 5 “high uptake” lesions undetectable by whole body radionuclide imaging in the thyroid gland. Of the 108 radioactive focal lesions diagnosed as metastatic lymph nodes by radionuclide imaging, 24 (22.2%) SPECT / CT changed their original conclusion (P <0.0001). Of SPECT / CT examinations, one of the 85 whole body radionuclide-positive lesions was negative (false positive); of the 20 lesions not identifiable by whole-body radionuclide imaging, 13 were positive, 7 A confirmed negative. The SPECT / CT examination also corrected for the three nuclide lesions that were false-negative. For distant metastases, 24 (40%) of 52 lesions were corrected by SPECT / CT (P <0.0001). Of SPECT / CT examinations, 1 of 32 lesions with a positive diagnosis of whole-body radionuclide imaging was confirmed as negative; 11 of the 20 lesions with undetectable whole-body radionuclide imaging were confirmed as positive and 9 confirmed Negative. For all 147 patients, the clinical staging and the treatment of 3 patients (2.0%) in 9 patients (6.1%) were changed by SPECT / CT. Conclusion Compared with whole body radionuclide imaging, SPECT / CT enhances the detection and localization accuracy of 131I in lymph node metastasis and distant metastasis.