摘要
目的 探索SPECT/CT标准化摄取值(standard uptake value,SUV)联合超声在预测甲状腺结节良恶性中的价值.方法 选取2022年4月至2024年5月经超声诊断为非囊性、甲状腺显像诊断为"非热结节"的92例甲状腺结节患者,择期行甲状腺甲氧基异丁基异腈(99mTc-MIBI)亲肿瘤显像及定量SPECT/CT检查,采用定参数自动勾画方式分别勾画感兴趣区(ROI)获得SUV值,以病理结果为"金标准".采用ROC曲线对SUV在对甲状腺结节良恶性进行评估时的灵敏度和特异度进行分析,获得诊断界值.采用配对x2检验比较分析定量SPECT/CT SUV值、超声及联合诊断对甲状腺结节良恶性的鉴别诊断效能.结果 92例患者中甲状腺恶性结节32例,良性结节60例,甲状腺恶性组平均标准化摄取值(SUVmean)和最大标准化摄取值(SUVmax)高于良性组,差异有统计学意义;ROC曲线结果提示SUVmean、SUVmax的诊断界值、曲线下面积(AUC)分别为2.57g/mL、0.840和5.17g/mL、0.892,SUVmax的诊断效能更高.SUVmax组、超声组及联合组诊断灵敏度分别为53.12％、75.00％、87.5％,特异度分别为88.33％、78.33％、83.33％,准确度分别为76.09％、77.17％、84.78％.配对 x2检验结果表明,超声和SUVmax组诊断的准确性有显著性差异(x2=20.488,P＜0.01),联合诊断的准确性优于SUVmax和超声(x 2=46.142,P＜0.01;x2=58.536,P＜0.01).ROC曲线结果显示三组的AUC分别为0.707、0.767、0.854,联合诊断效能最高.结论 精准定量SPECT/CTSUVmax值尤其是与超声联合诊断可以在穿刺活检或手术确诊前提高甲状腺恶性结节的检出率和诊断效能,其单独鉴别诊断甲状腺结节良恶性的诊断界值为5.17g/mL.
Abstract
Objective To explore the value of SPECT/CT standardized uptake value(SUV)combined with ultrasound in predicting benign and malignant thyroid nodules.Methods A total of 92 patients with thyroid nodules diagnosed as non cystic by ultrasound and non thermal nodules by thyroid imaging from April 2022 to May 2024 were selected.After undergoing thyroid imaging,99mTc-MIBI tumor imaging and quantitative SPECT/CT examination were performed at an appropriate time.The region of interest(ROI)was delineated using a fixed parameter automatic delineation method to obtain SUV values,with pathological results as the gold standard.Using ROC curves to analyze the sensitivity and specificity of SUVmean and SUVmax in evaluating benign and malignant thyroid nodules,and get the diagnostic cut-off value of SUVmax.Comparative analysis of quantitative SPECT/CT SUVmax,ultrasound,and combined diagnosis in the differential diagnosis of benign and malignant thyroid nodules using x 2 test.Results Among the 92 patients,there were 32 cases of malignant thyroid nodules and 60 cases of benign thyroid nodules.The SUVmax and SUVmean values in the malignant thyroid group were higher than those in the benign group,and the differences were statistically significant.The ROC curve results indicated that the SUVmean and SUVmax diagnostic thresholds,as well as the area under the curve(AUC)of tumor imaging were 2.57g/mL,0.840 and5.17g/mL,0.892 respectively.The diagnostic efficiency of SUVmax was higher.The diagnostic sensitivity of the SUVmax group,ultrasound group,and combination group were 53.12％,75.00％,and 87.5％,respectively,with specificity of 88.33％,78.33％,and 83.33％,and accuracy of 76.09％,77.17％,and 84.78％,respectively.The x 2 test results showed that there was a significant difference in the accuracy of diagnosis between the ultrasound and SUVmax groups(x 2=20.488,P＜0.01),and the accuracy of combined diagnosis was better than that of the SUVmax group and the ultrasound group(x 2=46.142,P＜0.01;x 2=58.536,P＜0.01).The ROC curve results showed that the AUC of the three groups were 0.707,0.767,and 0.854,respectively and the combined group had higher diagnostic efficiency.Conclusion Accurate quantification of SPECT/CT SUVmax values,especially in combination with ultrasound diagnosis,can improve the detection rate and diagnostic efficiency of thyroid malignant nodules before diagnosis through puncture biopsy or surgery.The diagnostic cut-off value for distinguishing benign and malignant thyroid nodules is 5.17g/mL.
基金项目
重庆市卫生健康委医学科研项目(2023WSJK123)
万方数据