99Tcm-MIBI SPECT/CT显像的不同本底对孤立性肺结节诊断效能的影响

摘要

Objective To assess the diagnostic accuracy of solitary pulmonary nodules while selecting different backgrounds in 99 Tcm‐MIBI SPECT/CT examination .Methods Totally 38 suspected solitary pulmonary nodules (SPN) were analyzed retrospectively .The lesions were divided into malignant group and benign group according to the pathological findings . We selected two different backgrounds , contralateral lung field ( DL ) and the contralateral soft tissue (NST) .The maximum counts and the mean counts of lesion to non‐lesion ratio (L/N) were calculated to evaluate diagnostic efficacy using ROC curve . The relationship between lesion size , pathological grading and L/N ratio was analyzed by Spearman correlation analysis . Results With DL and NST as the backgrounds ,the maximum counts and the mean counts of L/N between benign and malignant groups both differed significantly (all P<0 .05) .ROC curve analysis showed as follows :With DL and NST as the backgrounds ,the area under the curve (AUC) of L/DL‐MAX ,L/DL‐MEAN ,L/NST‐MAX ,and L/NST‐MEAN was 0 .73 ,0 .78 ,0 .80 and 0 .86 ,respectively .By pairwise comparison ,there was no significant difference (all P>0 .05) .The size and pathological grading of SPN did not affect 99 Tcm‐MIBI accumulation in the SPN (all P>0 .05) .Conclusion DL and NST both can be used as the background in diagnosis of pulmonary nodules on 99 Tcm‐MIBI SPECT/CT examination .The mean counts of the contralateral tissue used as the background can provide a stable result and a high diagnostic accuracy to assess the SPN .%目的：探讨行99 Tcm‐MIBI SPECT／CT断层显像时选取不同本底对孤立性肺结节诊断效能的影响。方法回顾性分析38例患者的孤立性肺结节，根据病理结果将其分为恶性组和良性组；分别选取病灶对侧肺野（DL ）及对侧软组织为本底，计算病灶／本底（L／N）最大计数值（MAX）以及平均计数值（MEAN），比较良恶性病灶组间差异并采用受试者工作特性（ROC ）曲线评价不同本底对鉴别诊断良恶性病灶的效能。病灶大小和病理学分级与L／N比值关系采用Spearman进行相关性分析。结果以对侧肺野及对侧软组织作为本底，良恶性组间L／N MAX以及MEAN的差异均有统计学意义（ P均＜0．05）。ROC曲线分析显示，以对侧肺野或对侧软组织作为本底，即 L／DL‐M AX、L／DL‐MEAN、L／NST‐MAX、L／NST‐MEAN的曲线下面积（AUC）分别为0．73、0．78、0．80、0．86，两两比较差异均无统计学意义（P均＞0．05）。病灶大小及恶性病灶病理分级与病灶L／N比值均无明显相关性（P均＞0．05）。结论采用99 Tcm‐MIBI SPECT／CT断层显像鉴别诊断肺结节时，对侧肺野及对侧软组织均可作为本底进行L／N比值计算。以对侧软组织为本底的平均值计算L／N比值略显优势，灵敏度及特异度均较高，可提供稳定、效能高的诊断结果。