南方医科大学学报

南方医科大学学报 ›› 2015, Vol. 35 ›› Issue (03): 422-.

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99Tcm-MIBI-SPECT与定位CT融合显像和18F-FDG-PET/CT融合显像鉴别孤立性肺结节的对比研究

邓智勇，李高峰，向旭东，贾莉，刘超，陈婷，刘长江   

  • 出版日期:2015-03-20 发布日期:2015-03-20

Comparative analysis of integrated 99mTc-MIBI-SPECT/localizable CT and integrated
18F-FDG-PET/CT for differential diagnosis of solitary pulmonary nodules

  • Online:2015-03-20 Published:2015-03-20

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摘要： 目的对比分析99Tcm-MIBI SPECT与定位CT融合显像和18F-FDG-PET/CT融合显像对孤立性肺结节（SPN）的鉴别诊断效率，
为中小城市医疗机构寻找一种较为廉价的鉴别SPN诊断方法。方法对39例SPN患者行99Tcm-MIBI-SPECT与定位CT融合显像，
46例SPN患者行18F-FDG-PET/CT融合显像。对两种显像结果进行定性及半定量分析。并根据最终诊断结果，对比分析两种显像
方法对SPN的鉴别诊断效率。结果39例SPN患者行99Tcm-MIBI-SPECT与定位CT融合显像，13例为恶性SPN，26例良性SPN。
99Tcm-MIBI-SPECT与定位CT融合显像定性分析对SPN良恶性鉴别诊断灵敏度92.31%（12/13）、特异性88.46%（23/26）、准确性
89.74%（35/39）、阳性预测值80%（12/15）、阴性预测值95.83%（23/24）。46例SPN患者行18F-FDG-PET/CT融合显像，29例为恶性
SPN，17例良性SPN。18F-FDG-PET/CT融合显像对SPN良恶性鉴别诊断灵敏度96.55%（28/29）、特异性76.47%（13/17）、准确性
89.13%（41/46）、阳性预测值87.50%（28/32）、阴性预测值92.86%（13/14）。99Tcm-MIBI-SPECT与定位CT融合显像和18F-FDG-PET/
CT融合显像鉴别SPN的灵敏度（χ2=0.356, P=0.55）、特异性（χ2=1.084, P=0.298）、准确性（χ2=0.008, P=0.927)、阳性预测值（χ2=
0.453, P=0.501）和阴性预测值（χ2=0.157, P=0.692）均无统计学差异。受试者工作特征（ROC）曲线分析显示：以99Tcm-MIBI早期摄
取比值（EUR）≥1.474为鉴别SPN良恶性界值，灵敏度100%，特异性76.90%；以99Tcm-MIBI延迟摄取比值（DUR）≥1.38为鉴别SPN
良恶性界值，灵敏度100%，特异性76.90%；以18F-FDG最大标准摄取比值（SUVmax）≥2.40为鉴别SPN良恶性界值，灵敏度96.60%，
特异性76.50%。EUR、DUR与SUVmax的ROC界值诊断灵敏度（Fisher精确检验P值分别为1.0和1.0）、特异性（Fisher精确检验P
值分别为1.0和1.0）差异无统计学意义。结论99Tcm-MIBI-SPECT与定位CT融合显像和18F-FDG-PET/CT融合显像对SPN的鉴别
诊断效率相似，99Tcm-MIBI-SPECT与定位CT融合显像可作为中小城市中低收入SPN患者较为实用的早期鉴别诊断方法。

Abstract: Objective To compare the diagnostic value of 99Tcm-MIBI SPECT/localizable CT and 18FDG-PET/CT in patients with
indeterminate solitary pulmonary nodules (SPNs) and assess the feasibility of using 99Tcm-MIBI SPECT/localizable CT as an
alternative when 18FDG-PET/CT is not available. Methods Thirty-nine patients with indeterminate SPNs were examined by
99Tcm-MIBI SPECT/localizable CT, and another 46 patients by 18FDG-PET/CT. The findings of the two modalities were analyzed
qualitatively and semiquantitatively to assess their efficacy for a definitive diagnosis of SNPs. Results Of the 39 patients
examined by 99Tcm-MIBI SPECT/localizable CT, 13 were identified to have malignant SPNs and 26 had benign SPNs; the
diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the
examination were 92.31% (12/13), 88.46% (23/26), 89.74% (35/39), 80% (12/15) and 95.83% (23/24), respectively. Of the 46 patients
receiving 18FDG-PET/CT examination, 29 malignant cases and 17 benign cases were identified with a diagnostic sensitivity,
specificity, accuracy, PPV and NPV of 96.55% (28/29), 76.47% (13/17), 89.13% (41/46), 87.50% (28/32) and 92.86% (13/14),
respectively. The two modalities showed no significant differences in the diagnostic sensitivity (χ2=0.356, P=0.55), specificity (χ2=
1.084, P=0.298), accuracy (χ2=0.008, P=0.927), PPV (χ2=0.453, P=0.501) or NPV (χ2=0.157, P=0.692). The ROC curve showed that
with the early uptake ratio (EUR) of 99Tcm-MIBI ≥1.474 and ≥1.38 as the cutoff values, the sensitivity of 99Tcm-MIBI SPECT/
localizable CT was both 100% and the specificity both 76.90%; with the maximum standard uptake value (SUVmax) of 18FDG ≥
2.40 as the cutoff value, the sensitivity of 18FDG-PET/CT was 96.60% and the specificity was 76.50%, showing no significant
differences between the two modalities in the diagnostic efficacy. Conclusion 99Tcm-MIBI-SPECT/ localizable CT may be a useful
and practical modality for early diagnosis of SNPs for patients with a medium or low income in small and medium-sized cities.