Department of Nuclear Medicine, Barts and The London School of Medicine and NHS Trust, Queen Mary, University of London, West Smithfield (QE II), London, UK.
Eur J Endocrinol. 2010 Jun;162(6):1131-9. doi: 10.1530/EJE-09-1023. Epub 2010 Mar 8.
The aim of the study was to assess the diagnostic performance of co-registered single photon emission computed tomography (SPECT)/computed tomography (CT) compared to Iodine-123 whole body gamma camera (WBGC) imaging and to SPECT alone in patients with differentiated thyroid cancer.
WBGC and SPECT/CT (n=85) imaging of the neck and thorax was performed in 79 consecutive patients. Three experienced observers reviewed: i) WBGC images followed by ii) SPECT alone, and iii) co-registered SPECT/CT. Foci of increased radioiodine uptake were classified on a five-point scale. Biopsy, other imaging modalities, and clinical follow-up served as the reference standard.
Twenty-two patients had local recurrence or metastatic thyroid cancer (11 were radioiodine negative), 9 had remnant thyroid tissue, and 54 had no evidence of disease. When classifying equivocal, probably, and definitely malignant findings as positive for malignancy, the sensitivity, specificity, positive predictive value, and negative predictive value were as follows: 41, 68, 31, and 77% for WBGC imaging; 45, 89, 59, and 82% for WBGC plus SPECT imaging; and 50, 100, 100, and 85% for WBGC plus SPECT/CT imaging respectively. The specificity was improved by the addition of SPECT (P=0.0002) and SPECT/CT (P<0.0001) than to WBGC imaging. SPECT/CT was also more specific than WBGC plus SPECT imaging (P=0.016). In a study-based analysis, SPECT/CT provided additional diagnostic information in 42% (36/85) of cases. SPECT/CT provided further characterization in 70% (63/90) of foci and improved the diagnostic confidence of all three observers.
The addition of SPECT/CT significantly improved the diagnostic information over Iodine-123 WBGC imaging and WBGC plus SPECT imaging alone.
本研究旨在评估同机配准单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）与碘-123 全身γ相机（WBGC）成像和单独 SPECT 相比在分化型甲状腺癌患者中的诊断性能。
对 79 例连续患者进行了颈部和胸部的 WBGC 和 SPECT/CT（n=85）成像。三位有经验的观察者分别对以下内容进行了回顾：i）WBGC 图像，然后是 ii）单独的 SPECT，和 iii）同机配准的 SPECT/CT。放射性碘摄取增加的病灶被分为五个等级。活检、其他成像方式和临床随访作为参考标准。
22 例患者有局部复发或转移性甲状腺癌（11 例为放射性碘阴性），9 例有残余甲状腺组织，54 例无疾病证据。当将不确定、可能和明确的恶性发现分类为恶性阳性时，灵敏度、特异性、阳性预测值和阴性预测值分别为：WBGC 成像为 41、68、31 和 77%；WBGC 加 SPECT 成像为 45、89、59 和 82%；WBGC 加 SPECT/CT 成像分别为 50、100、100 和 85%。与 WBGC 成像相比，SPECT（P=0.0002）和 SPECT/CT（P<0.0001）的添加提高了特异性。SPECT/CT 也比 WBGC 加 SPECT 成像更具特异性（P=0.016）。在基于研究的分析中，SPECT/CT 在 85 例（36/85）病例中提供了额外的诊断信息。SPECT/CT 在 90%（63/90）的病灶中提供了进一步的特征描述，并提高了所有三位观察者的诊断信心。
与碘-123 WBGC 成像和单独的 WBGC 加 SPECT 成像相比，SPECT/CT 的添加显著提高了诊断信息。
