99Tcm-HL91乏氧显像在甲状腺结节良恶性鉴别诊断中的应用

摘要

目的 评价99Tcm4,9-二氮-3,3,10,10-四甲基十二烷-2,11-二酮肟(HL91)对甲状腺结节良恶性鉴别诊断的临床价值.方法 对58例经触诊或超声检查存在甲状腺结节的患者进行99Tcm-HL91甲状腺早期(10 min)及延迟(4 h)平面显像,应用感兴趣区(ROI)技术计算靶/非靶(T/N)比值并进行比较.组间比较采用成组设计两样本均数t检验,率的比较用χ2检验.结果 患者均经手术或细针穿刺病理检查,其中21例为甲状腺癌,37例为甲状腺良性结节.99Tcm-HL91显像诊断甲状腺癌的灵敏度、特异性和准确性分别为85.7%,94.6%和91.4%,不同甲状腺癌病理类型的显像灵敏度差异无统计学意义(χ2=0.778,P＞0.05),但结节越大灵敏度越高.甲状腺癌与甲状腺良性结节组早期及延迟相T/N比值分别为1.07±0.04,1.25±0.03和0.92±0.10,0.91±0.12,组间在10 min时T/N比值差异无统计学意义(t=1.900,P＞0.05),4 h时T/N比值差异有统计学意义(t=3.885,P＜0.001).结论 用99Tcm-HL91乏氧显像判断甲状腺结节的良恶性有一定的临床价值,显像时间以4 h为佳.%Objective Recent studies showed that99Tcm-4,9-diaza-3,3,10,10-tetramethyldodecan-2.11-dizone dioxime(HL91)might be of potential in characterizing hypoxic areas within malignant tumors.The aims of this study were to use99Tcm-HL91 in patients with thyroid nodules and also to explore its clinical utilities in differentiate benign and malignant thyroid nodules.Methods Fifry-eight patients with thyroid nodules.detected either by ultrasound or physical palpation.were enrolled.99Tcm-HL91 planar thyroid images were performed at early(10 min after iniection)and delay(4 h after injection)phases.The radioactivity ratio of tumor to non-tumor(T/N)was calculated and compared with the pathological results.The t test and χ2 test were used for data analysis.Results Of the 58 patients,21 were thyroid cancer and 37 were benign nodules.The sensitivity.specificity and accuracy of99Tcm-HL91 for thyroid cancer were 85.7%.94.6%and 91.4%respectively.Moreover.the sensitivity was positively correlated with the tumor size and was unrelated to the histological types(χ2=0.778,P＞0.05).A significant higher uptake of 99Tcm-HL91 in malignant nodule was noted than benign at delay phase(1.25±0.03 vs 0.91 ±0.12.t=3.885.P＜0.001).Conclusion 99Tcm-HL91 hypoxic imaging has potential in both detecting and differentiating malignancy from benign thyroid nodules,especially when delay phase was applied.