生长抑素受体全身显像与SPECT/CT断层融合显像 诊断肾上腺嗜铬细胞瘤的临床价值

Clinical value of 99mTc-HYNIC-TOC whole-body scintigraphy versus single photon emission computed tomography/computed tomography in the diagnosis of adrenal pheochromocytoma

摘要:

目的：比较和评价生长抑素受体全身显像与SPECT/CT断层融合显像诊断肾上腺嗜铬细胞瘤的临床价值。方法：83例临床疑诊肾上腺嗜铬细胞瘤患者，均进行生长抑素受体全身显像与断层融合SPECT/CT显像，并与手术病理比较。结果：83例患者生长抑素受体全身显像阳性19例，其中17例病理证实为嗜铬细胞瘤，阴性64例中有24例病理为嗜铬细胞瘤；SPECT/CT断层融合显像阳性56例中的38例病理证实为嗜铬细胞瘤，阴性27例中有3例病理为嗜铬细胞瘤。生长抑素受体全身显像诊断肾上腺嗜铬细胞瘤的敏感度、特异度、准确性、阳性预测值及阴性预测值分别为41.5%、95.2%、68.7%、89.5%、62.5%，而断层融合显像诊断的敏感度、特异度、准确性、阳性预测值及阴性预测值分别为92.7%、57.1%、74.7%、67.9%、88.9%。通过生长抑素全身显像检测肾上腺嗜铬细胞瘤的肿瘤长径的ROC曲线示：AUC为0.735（95%CI=0.578～0.892，P=0.011），肿瘤长径的阳性诊断临界值为4.0 cm，诊断灵敏度为76.5%，特异度为75.0%。结论：生长抑素受体断层融合显像对肾上腺嗜铬细胞瘤的诊断较全身显像有更高的准确性、敏感性及阴性预测值，特别是对长径较小或囊实性病灶检出率明显高于全身显像。

Abstract:

Objective：To investigate the clinical value of 99mTc-HYNIC-TOC whole-body scintigraphy and single photon emission com－puted tomography/computed tomography（SPECT/CT） in the diagnosis of adrenal pheochromocytoma. Methods：A total of 83 patients suspected of adrenal pheochromocytoma were enrolled and underwent both 99mTc-HYNIC-TOC whole-body scintigraphy and SPECT/CT. The findings of 99mTc-HYNIC-TOC whole-body scintigraphy and SPECT/CT were compared with pathological results. Results：Of all 83 patients，19 obtained positive results of 99mTc-HYNIC-TOC whole-body scintigraphy，among whom 17 had pathologically confirmed pheochromocytoma；among the 64 patients with negative results on whole-body scintigraphy，24 had pathologically con－firmed pheochromocytoma. Among the 56 patients with positive results of SPECT/CT，38 had pathologically confirmed pheochromocy－toma；among the 27 patients with negative results of SPECT/CT，3 had pathologically confirmed pheochromocytoma. In the diagnosis of adrenal pheochromocytoma，99mTc-HYNIC-TOC whole-body scintigraphy had a sensitivity of 41.5%，a specificity of 95.2%，an accu－racy of 68.7%，a positive predictive value of 89.5%，and a negative predictive value of 62.5%，while SPECT/CT had a sensitivity of 92.7%，a specificity of 57.1%，an accuracy of 74.7%，a positive predictive value of 67.9%，and a negative predictive value of 88.9%. The receiver operating characteristic（ROC） curve of the long di－ameter of adrenal pheochromocytoma measured by 99mTc-HYN－IC-TOC whole-body scintigraphy showed that the long diameter of adrenal pheochromocytoma had an area under the ROC curve of 0.735（95% confidence interval：0.578-0.892，P=0.011） at the cut-off value of 4.0 cm，with a sensitivity of 76.5% and a specificity of 75.0% in diagnosis. Conclusion：Compared with 99mTc-HYNIC-TOC whole-body scintigraphy，SPECT/CT had higher accuracy，sensitivity，and negative predictive value in the diagnosis of adrenal pheochromocytoma，as well as a higher detection rate of tumor with a relatively short long diameter or solid-cystic lesions.