Enhancement value of SPECT/CT in diagnosis and treatment of differentiated thyroid carcinoma and therapeutic effect of high dose 131Ⅰ
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摘要:
目的探讨单光子发射型计算机断层显像与CT（SEPCT/CT）在分化型甲状腺癌诊治的增益价值及高剂量131Ⅰ 方法选取2018年1月~2020年1月在我院治疗的分化型甲状腺癌患者125例，所有患者行甲状腺全切术及清甲治疗，同时给予SPECT/CT、131Ⅰ全身扫描（131Ⅰ-WBS）检查。 结果125例患者最终诊断转移灶682处，其中摄碘转移灶589处，不摄碘转移灶93处；SPECT/CT诊断转移灶敏感度、准确率及阴性预测值分别为89.74%、88.77%和46.15%，高于131Ⅰ-WBS诊断（P < 0.05）；SPECT/CT和131Ⅰ-WBS诊断转移灶特异性、阳性预测值比较差异无统计学意义（P>0.05）；SPECT/CT使32例患者治疗方案有所调整，占25.60%；术后高剂量131Ⅰ治疗总有效率为71.20%；不同性别、术式、BMI患者治疗总有率比较差异无统计学意义（P>0.05）；年龄 < 50岁、临床分期Ⅰ~Ⅱ期患者治疗总有效率高于年龄≥50岁、Ⅲ~Ⅳ患者（P < 0.05）。 结论SPECT/CT有助于分化型甲状腺癌诊断，调整治疗方案，高剂量131Ⅰ治疗效果与患者年龄、临床分期有一定关系。 -
关键词:
- 单光子发射型计算机断层显像 /
- CT /
- 分化型甲状腺癌 /
- 增益价值 /
- 高剂量131Ⅰ治疗
Abstract:ObjectiveTo investigate the gain value of single photon emission computed tomography and computed tomography (SPECT/CT) in the diagnosis and treatment of differentiated thyroid cancer and the therapeutic effect of high-dose 131Ⅰ. MethodsA total of 125 patients with differentiated thyroid cancer who were treated in our hospital from January 2018 to January 2020 were selected. The patients were performed with thyroidectomy and debridement in our hospital, and SPECT/CT and 131Ⅰ-whole body scan (WBS) were performed. ResultsA total of 682 metastatic foci were finally diagnosed in 125 patients, including 589 metastatic foci taking iodine and 93 metastatic foci not taking iodine. The sensitivity, accuracy and negative predictive values of SPECT/CT in diagnosis of metastases were 89.74%, 88.77% and 46.15%, respectively, which were higher than those of 131Ⅰ-WBS (P < 0.05). There was no significant difference in the specificity and positive predictive value between SPECT/CT and 131Ⅰ-WBS in the diagnosis of metastasis (P>0.05). SPECT/CT changed the treatment plan of 32 patients (25.60%). The total effective rate of high dose 131Ⅰ after operation was 71.20%.There was no significant difference in total treatment rate among patients with different genders, operation methods and body mass index (P>0.05). The treatment total effective rate in patients with age < 50 years old, clinical stage Ⅰ-Ⅱ were significantly higher than the age ≥50, Ⅲ-Ⅳ patients (P < 0.05). ConclusionSPECT/CT is helpful for the diagnosis and treatment of differentiated thyroid cancer, the therapeutic effect of high-dose 131Ⅰ is related to the age and clinical stage of patients. -
图 1 某患者131Ⅰ-WBS和SPECT/CT图像
A：131Ⅰ-WBS图像；B~E：SPECT/CT图像.
Figure 1. 131Ⅰ-WBS and SPECT/CT of a patient.
表 1 SPECT/CT、131Ⅰ-WBS诊断转移灶比较
Table 1. Comparison of SPECT/CT and 131Ⅰ-WBS in the diagnosis of metastases (%)
方法 敏感度 特异性 准确率 阳性预测值 阴性预测值 SPECT/CT 89.74(612/682) 80.00(60/75) 88.77(672/757) 97.61(612/627) 46.15(60/130) 131Ⅰ-WBS 79.47(542/682) 78.02(71/91) 79.30(613/773) 96.44(542/562) 33.65(71/211) χ2 4.545 0.097 25.504 1.411 5.317 P 0.033 0.756 0.000 0.235 0.021 131Ⅰ-WBS：131Ⅰ全身扫描. 
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表 2 不同患者治疗疗效比较
Table 2. Comparison of therapeutic effects of different patients[n (%)]
组别 治疗总有效率χ2 P 性别 0.092 0.762 男(n=29) 20(68.97) 女(n=96) 69(71.88) 年龄(岁) 12.703 < 0.001 < 50(n=66) 56(84.85) ≥50(n=59) 33(55.93) BMI(kg/m2) 0.183 0.669 > 24(n=80) 58(72.50) ≤24(n=45) 31(68.89) 手术方式 0.953 0.329 单纯全切(n=54) 36(66.67) 全切+淋巴结清扫(n=71) 53(74.65) 临床分期 13.838 < 0.001 Ⅰ~Ⅱ(n=80) 66(82.50) Ⅲ~Ⅳ(n=45) 23(51.11)
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