Department of Nuclear Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Korean J Radiol. 2023 Nov;24(11):1142-1150. doi: 10.3348/kjr.2023.0411.
To evaluate technetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid (Tc-3PRGD) single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging for diagnosing lymph node metastasis of primary malignant lung neoplasms.
We prospectively enrolled 26 patients with primary malignant lung tumors who underwent Tc-3PRGD SPECT/CT and F-fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/CT imaging. Both imaging methods were analyzed in qualitative (visual dichotomous and 5-point grades for lymph nodes and lung tumors, respectively) and semi-quantitative (maximum tissue-to-background radioactive count) manners for the lymph nodes and lung tumors. The performance of the differentiation of lymph nodes with and without metastasis was determined at the per-lymph node station and per-patient levels using histopathological results as the reference standard.
Total 42 stations had metastatic lymph nodes and 136 stations had benign lymph nodes. The differences between metastatic and benign lymph nodes in the visual qualitative and semiquantitative analyses of Tc-3PRGD SPECT/CT and F-FDG PET/CT were statistically significant (all < 0.001). The area under the receiver operating characteristic curve (AUC) in the semi-quantitative analysis of Tc-3PRGD SPECT/CT was 0.908 (95% confidence interval [CI], 0.851-0.966), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.86 (36/42), 0.88 (120/136), 0.69 (36/52), and 0.95 (120/126), respectively. Among the 26 patients (including two patients each with two lung tumors), 15 had pathologically confirmed lymph node metastasis. The difference between primary lung lesions in patients with and without lymph node metastasis was statistically significant only in the semi-quantitative analysis of Tc-3PRGD SPECT/CT ( = 0.007), with an AUC of 0.807 (95% CI, 0.641-0.974).
Tc-3PRGD SPECT/CT imaging may notably perform in the direct diagnosis of lymph node metastasis of primary malignant lung tumors and indirectly predict the presence of lymph node metastasis through uptake in the primary lesions.
评估锝-3 聚乙二醇聚精氨酸-甘氨酸-天冬氨酸（Tc-3PRGD）单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）成像在诊断原发性恶性肺肿瘤淋巴结转移中的作用。
我们前瞻性地纳入了 26 例接受 Tc-3PRGD SPECT/CT 和 F-氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）/CT 成像的原发性恶性肺肿瘤患者。对淋巴结和肺部肿瘤分别采用定性（淋巴结和肺部肿瘤分别为视觉二分法和 5 分制）和半定量（最大组织与背景放射性计数比）方法分析两种成像方法。以组织病理学结果为参考标准，在淋巴结站和患者水平上确定有和无转移的淋巴结的区分性能。
共 42 个淋巴结站存在转移性淋巴结，136 个淋巴结站存在良性淋巴结。Tc-3PRGD SPECT/CT 和 F-FDG PET/CT 的视觉定性和半定量分析中，转移性和良性淋巴结之间的差异具有统计学意义（均<0.001）。Tc-3PRGD SPECT/CT 半定量分析的受试者工作特征曲线（AUC）下面积为 0.908（95%置信区间[CI]：0.851-0.966），灵敏度、特异性、阳性预测值和阴性预测值分别为 0.86（36/42）、0.88（120/136）、0.69（36/52）和 0.95（120/126）。在 26 例患者（包括 2 例各有 2 个肺部肿瘤的患者）中，有 15 例经病理证实存在淋巴结转移。仅在 Tc-3PRGD SPECT/CT 的半定量分析中，有和无淋巴结转移患者的原发性肺部病变之间存在统计学显著差异（=0.007），AUC 为 0.807（95%CI：0.641-0.974）。
Tc-3PRGD SPECT/CT 成像在原发性恶性肺肿瘤淋巴结转移的直接诊断中可能具有明显作用，并通过原发性病变摄取间接预测淋巴结转移的存在。
