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目的探讨~(201)Tl显像在肢体软组织良恶性病变鉴别诊断中的临床价值。方法 2003年6月～2006年2月,对55例肢体软组织病变患者进行~(201)Tl显像检查。其中恶性肿瘤33例,良性病变22例,所有病例的诊断均经活检或手术后组织学证实。静脉注射~(201)Tl 111MBq后15min(早期)和3h(延迟期)分别显像,进行肉眼分析并计算早期摄取比值(EUR)、延迟期摄取比值(DUR)及滞留指数(RI)。对比恶性组和良性病变组早期摄取比值、延迟期摄取比值及滞留指数,并分别行t检验进行半定量分析。结果半定量分析33例恶性病变和22例良性病变的EUR分别为3.00±2.60和1.77±1.04,两者的差异有显著性意义(t=2.468,P<0.05);两者的DUR分别为2.13±1.40和1.39±0.06,差异有显著性意义(t=2.663,P<0.05)。两组间RI差异无显著性意义(t=0.661,P>0.5)。本研究判断肢体软组织恶性病变标准:(1)RI正值首先考虑恶性病变;(2)EUR>1.7且DUR>1.4首先考虑恶性病变;(3)脂肪来源肿瘤EUR>1.2提示为恶性肿瘤。以此标准判断本组肢体软组织病变良恶性,则敏感性为84.8%、特异性为77.3%、准确性为81.8%。结论 ~(201)Tl显像可作为肢体软组织良恶性病变鉴别诊断的影像学检查方法。
Objective To investigate the clinical value of ~ (201) Tl imaging in differential diagnosis of benign and malignant limb soft tissues. Methods From June 2003 to February 2006, ~ (201) Tl imaging was performed in 55 cases of limb soft tissue lesions. 33 cases of malignant tumors, 22 cases of benign lesions, all cases of diagnosis by biopsy or postoperative histological confirmed. Intravenous injection of ~ (201) Tl 111MBq after 15min (early) and 3h (delayed phase) were visualized and analyzed by eye and calculate the early intake ratio (EUR), delayed intake ratio (DUR) and retention index (RI). The ratio of early uptake, delay uptake and retention index were compared between malignant group and benign group, and t-test was used for semi-quantitative analysis. Results The semi-quantitative analysis of 33 cases of malignant lesions and 22 cases of benign lesions were EUR 3.00 ± 2.60 and 1.77 ± 1.04, the difference was significant (t = 2.468, P <0.05); the DUR of the two were 2.13 ± 1.40 and 1.39 ± 0.06 respectively, with significant difference (t = 2.663, P <0.05). There was no significant difference in RI between the two groups (t = 0.661, P> 0.5). The criteria for malignant lesions of limbs in this study were as follows: (1) Positive RI values were considered first for malignant lesions; (2) EUR> 1.7 and DUR> 1.4 first for malignant lesions; and (3) EUR> 1.2 for adipose-derived tumors was suggestive of malignancy. Using this standard to determine the benign and malignant soft tissue lesions in this group, the sensitivity was 84.8%, the specificity was 77.3% and the accuracy was 81.8%. Conclusion ~ (201) Tl imaging can be used as a differential diagnosis of benign and malignant soft tissue lesions of the imaging method.