Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
Br J Radiol. 2012 Jul;85(1015):e307-13. doi: 10.1259/bjr/10438644.
A contrast-enhanced multidetector CT (MDCT) scan is the first choice examination when evaluating patients with suspected lung cancer. However, while the clinical focus is on CT, research focus is on molecular biological methods whereby radiolabelled pharmaceuticals are injected into participants and target malignant lung tumours. We examined whether a contrast-enhanced MDCT scan supplied with an additional non-contrast enhanced high-resolution CT scan, or a newer but more expensive (99m)Tc depreotide single photon emission CT (SPECT) scan, was the better first-choice examination for the work-up of pulmonary lesions. Furthermore, we examined whether a (99m)Tc depreotide SPECT scan was an appropriate second-choice examination for patients with indeterminate lesions.
140 participants were included in the analysis. CT images were given a malignancy potential rating of 1, 2 or 3 with higher rating being indicative of disease. (99m)Tc depreotide SPECT images were graded either positive or negative. Histopathology and CT follow-up were used as reference standard. Sensitivity, specificity and diagnostic accuracy were calculated.
Overall sensitivity, specificity and diagnostic accuracy of CT were 97%, 30% and 84%, respectively. Overall sensitivity, specificity and diagnostic accuracy of (99m)Tc depreotide SPECT were 94%, 58% and 76%, respectively. For indeterminate lesions sensitivity, specificity and diagnostic accuracy of (99m)Tc depreotide SPECT were 71%, 68% and 69%, respectively.
Both CT and (99m)Tc depreotide SPECT made valuable contributions to the evaluation of pulmonary lesions. (99m)Tc depreotide SPECT results were not superior to CT results and did not contribute further to the diagnostic work-up. Regarding indeterminate lesions,( 99m)Tc depreotide SPECT sensitivity was too low.
在评估疑似肺癌患者时，增强多排螺旋 CT（MDCT）扫描是首选检查方法。然而，虽然临床重点是 CT，但研究重点是分子生物学方法，即向参与者注射放射性标记药物，以靶向恶性肺肿瘤。我们研究了增强 MDCT 扫描是否结合非增强高分辨率 CT 扫描，或者较新但更昂贵的（99m）Tc 喷替酸单光子发射 CT（SPECT）扫描，是肺部病变检查的更好首选检查。此外，我们还研究了（99m）Tc 喷替酸 SPECT 扫描是否是不确定病变患者的合适二线检查。
对 140 名参与者进行了分析。将 CT 图像的恶性潜能评分定为 1、2 或 3，评分越高表明疾病的可能性越大。（99m）Tc 喷替酸 SPECT 图像评分阳性或阴性。将组织病理学和 CT 随访作为参考标准。计算了敏感性、特异性和诊断准确性。
CT 的总体敏感性、特异性和诊断准确性分别为 97%、30%和 84%。（99m）Tc 喷替酸 SPECT 的总体敏感性、特异性和诊断准确性分别为 94%、58%和 76%。对于不确定的病变，（99m）Tc 喷替酸 SPECT 的敏感性、特异性和诊断准确性分别为 71%、68%和 69%。
CT 和（99m）Tc 喷替酸 SPECT 均对肺部病变的评估有价值。（99m）Tc 喷替酸 SPECT 结果并不优于 CT 结果，对诊断性检查也没有进一步贡献。对于不确定的病变，（99m）Tc 喷替酸 SPECT 的敏感性太低。
