摘要
目的探讨受试者工作特征(ROC)曲线分析^(99)Tc^m -MIBI 显像对甲状腺冷结节的诊断效能。方法 68例^(99)Tc^m O_4^-甲状腺显像为单发冷结节的患者,行^(99)Tc^m-MIBI 甲状腺显像,分别计算肿瘤和对侧正常甲状腺组织(T/N)15 min(ER)和120 min(DR)摄取比值,以 T/N 的 DR=0.8作为诊断恶性病变的阈值。同时还计算肿瘤和颌下腺(T/S)、肿瘤和心脏(T/H)ER、DR,用 ROC 曲线分析法找出上述指标对甲状腺癌诊断的最佳阈值。结果经活组织检查或手术病理检查证实良性病变60例,恶性病变8例。半定量分析^(99)Tc^m-MIBI 显像的灵敏度、特异性和准确性分别为100.0%、76.7%和79.4%,从 ROC 曲线的界值点找到 DR 最佳界点(T/N=0.995、T/S=0.995、T/H=1.005),以其作为诊断良恶性的阈值,三者的灵敏度分别为100.0%、87.5%、75.0%,特异性各为90.0%、85.0%、83.3%,其曲线下面积(AUC)分别为0.949,0.876,0.867,均大于相应的 ER AUC。T/N 阈值0.8和0.995对甲状腺癌诊断结果差异有统计学意义(χ~2=6.125,P<0.05)。结论 ROC曲线分析法能提高^(99)Tc^m-MIBI 发对甲状腺结节的诊断效能。
Objective More studies have found that 99^Tc^m-MIBI thyroid imaging may provide more differential diagnostic value than traditional 99^Tc^mO4^- thyroid imaging. This study attempted to analyze the receiver operating characterostoc （ROC） curves to verify the additional diagnostic value of 99^Tc^m-MIBI over 99^Tc^mO4^- thyroid imaging in the differentiation of the ＂cold＂ nodules. Methods Sixty-eight patients initially diagnosed with ＂cold＂ nodules in 99^Tc^mO4^- thyroid scintigraphy were selected for further 99^Tc^m-MIBI thyroid imaging at early （15 min after 99^Tc^m-MIBI intravenous injection, ER） and delayed phase （2 h after injection, DR）. Semi-quantitative analysis was performed using tumor/normal tissue （T/N） ratio both at ER and DR, with 0.8 defined as the threshold for differential diagnoses. In ROC curves analyses, the ratios form tumor/submaxillary gland （T/S） and tumor/heart （T/H） were derived to obtain the most proper differential diagnostic thresholds. Results Of all patients with the ＂cold＂ nodules, only eight cases were finally diagnosed on pathology with thyroid malignancy, while other 60 were benign. For differential diagnoses, the sensitivity, specificity and accuracy of semi-quantitative 99^Tc^m-MIBI thyroid imaging were 100. 0%, 76.7% and 79.4% respectively. However, with thresholds of T/N =0. 995, T/S = 0. 995, T/H = 1. 005 derived from ROC curves for DR 99^Tc^m-MIBI imaging, the differential diagnostic sensitivities were 100.0%, 87.5%, 75.0% and the specificities were 90.0%, 85.0%, 83.3% respectively. The areas under the ROC curves were 0.949, 0.876 and 0. 867 respectively for DR, all significantly larger than those of ER. Statistical difference was also evident between threshold values of 0. 8 and 0. 995 （χ^2 =6. 125, P 〈 0. 05）. Conclusions ROC curves derived from 99^Tc^m-MIBI thyroid imaging provide additional diagnostic value over 99^Tc^mO4^- thyroid imaging for the differentiation of the ＂cold＂ nodules. For 99^Tc^m-MIBI thyroid imaging, DR is more valuable than ER in the ROC curves analyses.
出处
《中华核医学杂志》
CAS
CSCD
北大核心
2007年第3期180-182,共3页
Chinese Journal of Nuclear Medicine
