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目的探讨99mTc-甲基异丁基异腈(99mTc-MIBI)显像在鉴别胸腺良恶性包块中的应用价值。方法行99mTc-MIBI肿瘤阳性显像的病人32例,注射显像剂后分别采集早期相(注射后15min)与延迟相(注射后2h)平面图像,记录各时相肿瘤与肺部血池放射性计数比值(T/N比值),并分别计算洗脱率与滞留率。术后按病理结果将病人分为胸腺良性病变组、低度恶性胸腺瘤组(胸腺瘤A型、AB型)与中度恶性胸腺瘤组(胸腺瘤B1、B2、B3型)。结果胸腺良性病变组绝大多数包块早期相与延迟相未见明显放射性摄取(1例多房性胸腺囊肿除外),胸腺瘤组绝大多数包块两时相可见不同程度的放射性摄取(其中1例B3型除外),诊断的灵敏度达95.24%,特异度达90.91%。胸腺良性病变组早期相和延迟相T/N比值差异无显著性(P>0.05)。低度与中度恶性胸腺瘤组早期相和延迟相T/N比值差异均有显著性(t=2.333、-4.995,P<0.05)。3组早期相及延迟相T/N比值比较,差异均有显著性(F=19.514、19.072,P<0.001),其中良性病变组与中度恶性胸腺瘤组比较差异无显著意义(P>0.05)。低度恶性胸腺瘤组2h洗脱率为(5.778±7.716)%,中度恶性胸腺瘤组2h滞留率为(13.315±9.410)%。结论根据胸腺包块对显像剂的摄取与否能够初步鉴别包块的良恶性,同时根据包块摄取的T/N比值以及早期相至延迟相T/N比值的变化,可以进一步判断胸腺瘤的恶性程度。
Objective To investigate the value of 99mTc-methyl isobutyl isonitrile (99mTc-MIBI) imaging in differentiating benign and malignant thymus masses. Methods Totally 32 patients with 99m Tc-MIBI tumor positive imaging were collected. The imaging images of the early phase (15 min after injection) and the delayed phase (2 h after injection) were collected respectively. The radioactivity of tumor and pulmonary blood pool Count ratio (T / N ratio), and calculate the elution rate and retention rate respectively. According to the pathological results, the patients were divided into benign thymus lesions group, low-grade thymoma group (Thymoma type A, AB type) and moderate malignant thymoma group (Thymoma type B1, B2, B3). Results Most of thymus benign lesions showed no significant radioactive uptake in the early and late phases (except for 1 case of multi-thymus cysts), and most of the thymoma group showed different degrees of radioactivity uptake 1 case of type B3 except), the diagnostic sensitivity of 95.24%, specificity of 90.91%. There was no significant difference in the T / N ratio of early phase and delayed phase in benign thymus lesions (P> 0.05). There was significant difference in the ratio of T / N between the early phase and the delayed phase in the group of low and moderate thymoma (t = 2.333, -4.995, P <0.05). There were significant differences in the ratio of T / N between the early phase and the delayed phase in the three groups (F = 19.514, 19.072, P <0.001), but there was no significant difference between the benign lesion group and the moderate malignant thymoma group (P> 0.05 ). The rate of 2h elution was (5.778 ± 7.716)% in the patients with low grade malignant thymoma, and (13.315 ± 9.410)% in the patients with moderate and severe thymoma. Conclusion According to the thymus mass imaging agent uptake or not can initially identify the benign and malignant mass, according to the T / N ratio of mass ingestion and early phase to delayed phase T / N ratio changes can further determine the thymoma The degree of malignancy.