99mTc-3PRGD2 SPECT/CT显像联合增强CT评估肺部肿瘤淋巴结转移的诊断价值：基于41例患者的前瞻性临床试验
doi: 10.12122/j.issn.1674-4500.2023.01.02
99mTc-3PRGD2 SPECT/CT imaging combined with enhanced CT to evaluate the diagnostic value of lung tumor lymph node metastasis
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摘要:
目的 探讨99mTc-3PRGD2 SPECT/CT显像结合增强CT评估胸部肿块淋巴结转移的诊断价值。 方法 前瞻性招募41位患有可疑肺部病变的受试者，分别行99mTc-3PRGD2 SPECT/CT显像和增强CT影像学检查，并行肿瘤切除及淋巴结清扫术，记录上述各项检查对肺部肿瘤淋巴结转移检出情况，以患者手术病理检查或随访情况作为确诊依据。病理结果为“金标准”，分析99mTc-3PRGD2显像、肺部增强CT及二者联合判断肺部恶性肿瘤淋巴结是否转移的诊断能力，分析其敏感度、特异性、准确度、阳性预测值及阴性预测值。 结果 99mTc-3PRGD2显像、增强CT及二者联合诊断肺部肿瘤淋巴结转移的敏感度、特异性、准确度、阳性预测值、阴性预测值分别为54.6%（6/11）、68.4%（13/19）、63.3%（19/30）、50.0%（6/12）、72.2%（13/18），72.3%（8/11）、47.4%（9/19）、56.7%（17/30）、44.4%（8/18）、75.0%（9/12）和81.8%（9/11）、89.5%（17/19）、86.7%（26/30）、81.8%（9/11）、89.5%（17/19）。99mTc-3PRGD2显像的诊断能力相对增强CT的特异性高，敏感度低。两种方法联合诊断胸部的恶性肿瘤淋巴结转移的诊断效能预测指标均高于单独应用增强CT（χ2=6.914，P=0.009）和99mTc-3PRGD2显像（χ2=7.751，P=0.005）。Kappa检验显示99mTc-3PRGD2 SPECT/CT显像、增强CT和二者联合诊断与病理结果的一致性分别为0.225、0.177、0.713（P>0.05），差异无统计学意义。 结论 胸部增强CT联合99mTc-3PRGD2 SPECT/CT显像对于诊断肺部肿瘤淋巴结的转移有很高的准确性，有助于患者的手术决策。 -
关键词:
- 99mTc-3PRGD2 SPECT/CT显像 /
- 增强CT /
- 肺部肿瘤 /
- 淋巴结转移
Abstract:Objective To investigate the diagnostic value of 99mTc-3PRGD2 SPECT/CT imaging combined with enhanced CT for the evaluation of lymph node metastasis in chest masses. Methods Forty-one patients with suspected lung lesions were prospectively recruited and underwent 99mTc-3PRGD2 SPECT/CT imaging and enhanced CT imaging with tumor resection and lymph node dissection. The detection of lymph node metastasis in lung tumors was recorded. The pathological results were used as the "gold standard" to analyze the diagnostic ability of 99mTc-3PRGD2 imaging, lung-enhanced CT and the combination of both to determine whether lymph node metastasis of lung malignant tumors were detected. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were measured. Results The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 99mTc-3PRGD2 imaging, enhanced CT, and the combination of the two for the diagnosis of lymph node metastasis in lung tumors were 54.6% (6/11), 68.4% (13/19), 63.3% (19/30), 50.0% (6/12), 72.2% (13/18); 72.3% (8/11), 47.4% (9/19), 56.7% (17/30), 44.4% (8/18), 75.0% (9/12); 81.8% (9/11), 89.5% (17/19), 86.7% (26/30), 81.8% (9/11), 89.5% (17/19). The diagnostic power of 99mTc-3PRGD2 imaging relative to enhanced CT ability was relatively high in specificity and low in sensitivity compared to enhanced CT. The diagnostic efficacy of both methods was higher than that of enhanced CT (χ2=6.914, P=0.009) and 99mTc-3PRGD2 imaging (χ2=7.751, P=0.005) alone for the diagnosis of malignant lymph node metastasis in the chest. The concordance of diagnostic and pathological findings using Kappa test comparing 99mTc-3PRGD2 SPECT/CT imaging, enhanced CT and both combined were 0.225, 0.177, 0.713, respectively, which were not statistically different (P>0.05). Conclusion Chest-enhanced CT combined with 99mTc-3PRGD2 SPECT/CT imaging has high accuracy in diagnosing lymph node metastasis of lung tumors and helps patients' surgical decision. -
Key words:
- 99mTc-3PRGD2 SPECT/CT imaging /
- enhanced CT /
- lung tumor /
- lymph node metastasis
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图 1 肺腺癌患者影像学表现（男，62岁）
A~B：99mTc-3PRGD2 SPECT/CT显像，分别为最大密度投影图（A）、横断位纵膈肺门淋巴结显像（B）, 可见4区（气管旁下区）淋巴结有显像剂摄取; 同时在增强CT（C）上可见4区肿大淋巴结有显著强化, 增加值>20 Hu, 结合原发灶形态及强化方式, 考虑恶性肿瘤伴淋巴结转移; D: 淋巴结病理证实为肺腺癌（HE，×400）
Figure 1. Imaging findings of lung adenocarcinoma patient (male, 62 years old).
图 2 肺结核患者影像学表现（男，61岁）
A~B: 99mTc-3PRGD2 SPECT/CT显像, 分别为最大密度投影图（A）、横断位纵膈肺门淋巴结显像（B），可见患者7区（隆突下）淋巴结有显像剂中度摄取; 同时增强CT（C）也显示7区（隆突下）淋巴结有蛋壳样环形强化, 结合原发灶的形态及强化方式, 考虑为结核; D: 淋巴结病理证实为其内有炎细胞浸润及干酪性坏死, 考虑为结核（HE，×400）.
Figure 2. Imaging findings of a patient with pulmonary tuberculosis (male, 61 years old).
图 3 左上肺曲霉菌患者影像学表现（男，70岁）
A~C: 99mTc-3PRGD2 SPECT/CT显像, 分别为最大密度投影图（A）、横断位纵膈肺门淋巴结显像（B）、原发灶显像（C）, 可见该例曲霉菌患者并未见明显纵膈淋巴结显像剂摄取，但原发灶有强烈摄取; D: 该例患者的增强CT, 原发灶可见均匀强化, 同时可见曲霉菌典型空气半月征, 多区肿大淋巴结轻度均匀强化; E: 病理图可见其内有真菌丝，证实为真菌感染（HE，×400）.
Figure 3. Imaging findings of a patient with left upper lung Aspergillus (male, 70 years old).
表 1 三种诊断方法诊断肺部肿瘤淋巴结转移诊断效能比较
Table 1. Comparison of diagnostic efficacy of three diagnostic methods for lymph node metastasis in lung tumors (%)
方法 敏感度 特异性 准确性 阳性预测值 阴性预测值 增强CT 72.3（8/11） 47.4(9/19) 56.7(17/30) 44.4(8/18) 75.0(9/12) SPECT 54.6（6/11） 68.4(13/19) 63.3(19/30) 50.0(6/12) 72.2(13/18) 增强CT联合SPECT 81.8(9/11) 89.5(17/19) 86.7(26/30) 81.8(9/11) 89.5(17/19) 
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表 2 三种检查方法诊断结果与术后病理对照
Table 2. Diagnostic results of the three examination methods compared with postoperative pathology (n, n=41)
病理 增强CT 合计 99mTc-3PRGD2 SPECT/CT 合计 二者联合 合计 + - + - + - 恶性 8 10 18 6 6 12 9 2 11 良性 3 9 12 5 13 18 2 17 19 合计 11 19 30 11 19 30 11 19 30 注: 增强CT、99mTc-3PRGD2 SPECT/CT和二者联合的Kappa值分别为0.177、0.225、0.713, P > 0.05.
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