| [Objectiv] To evaluate the value of molecular imaging of hypoxic cell in diagnosis of thyroid cold nodules, through researching the value of 99mTc-HL91 hypoxia imaging in diagnosis of thyroid cold nodules.[Methods] 30 patients who the 99TcmO4- static imaging prompt cold nodules underwent 99Tcm-HL91 Early (10min), middle (2h) and late-phase (4h) hypoxia imaging before operation including planar imaging and tomography. And then analyzing the imaging results with qualitative and semi-quantitative method. Qualitative analysis:The positive standard is that cold nodule was filled or partially filled with 99Tcm-HL91,and no significant dissipation in delayed imaging; And if there was not filled or filled with 99Tcm-HL91 in the early phase but disappeared in the delayed phase,it is negative. Semi-quantitative analysis:Sketching the same outline regions of interest using ROI in thyroid nodules, the contralateral normal thyroid tissue and the region below thyroid of early, middle and late phase respectively. Then calculating radioactive counts and tumor to normal ratio (T/N ratio),early ratio(ER), delayed ratio DR (DR of delayed imaging in 2 hour is DR1, DR of delayed imaging in 4 hour is DR2),retention index RI (RI of delayed imaging in 2 hour is RI1, RI of delayed imaging in 4 hour is RI2).Finally, doing the appropriate statistical analysis with all these results.[Results] According to the biopsy results,12 out of 30 were identified with benign tumor, including 1 nodular goiter,1 subacute thyroiditis,6 thyroid adenoma,3 chronic lymphocytic thyroiditis(Hashimoto's disease),1 thyroid cyst; 18 out of 30 were identified with malignant tumor, including 10 carcinoma,4 cases of follicular carcinoma,2 cases of medullary carcinoma,1 case of undifferentiated carcinoma,1 case of thyroid lymphoma.Qualitative analysis:In benign group,2 patients which 99Tcm-HL91 imaging were positive,10 cases which 99Tcm-HL91 imaging were negative; And in 18 cases malignant lesions,16 out of 18 were positive with 99Tcm-HL91 imaging,2 out of 18 were negative. The diagnostic sensitivity was 88.9%(16/18) and specificity was 83.3% (10/12) and accuracy of 86.7%(26/30)Semi-quantitative analysis:In benign group, the T/N average value (With mean±standard deviation)of three phases was respectively 0.90±0.12,0.92±0.11, 0.93±0.16, And the T/N average value of malignant group was 1.17±022,1.41±0.39,1.86±0.58.The differences between benign group and malignant group about T/ N ratio of three phases were all statistically significant, P＜0.001.There is no significant difference among T/N ratio of three phases in benign group, P＞0.05. The differences of T/N ratio between 4h and 10min or 2h in malignant group were significant, The values of P were 0.000 and 0.002。The difference between 10 min and 2h about T/N ratio was not statistically significant, P＞0.05. Taking X-SD of malignant group of T/N average value as threshold, 10min diagnostic sensitivity was 77.8%(14/18) and specificity was 66.7%(8/12),accuracy was 73.3% (22/30),2h diagnostic sensitivity,specificity and accuracy was 94.4%(17/18),83.3%(10/12),90% (27/30) respectively.4h was 94.4%(17/18),91.7%(11/12),93.3%(28/30)The ER and DR of benign group are as follows. ER was 0.77±0.27, DRl was 0.83±0.22, DR2 was 0.86±0.3.And the ER and DR of malignant group was respectively 1.37±0.46,1.97±0.91,3.13±1.50. The differences between benign group and malignant group about ER, DR1, DR2 were all statistically significant, P＜0.001.There is no significant difference among ER, DR1, DR2 in benign group, P＞0.05.The differences between DR2 and ER or DRl in malignant group were significant, The values of P were 0.000 and 0.002.The difference between ER and DR1 was not statistically significant, P＞0.05. And taking X- SD of malignant group of ER, DR1, DR2 as threshold value, the sensitivity of diagnosis of early-phase was 77.8%(14/18) and specificity was 66.7%(8/12), accuracy was 73.3%(22/30), to delayed 2h, the diagnostic sensitivity was 88.9%(16/18), specificity was 83.3% (10/12), accuracy was 86.7%(26/30), delayed 4h,the diagnostic sensitivity, specificity, accuracy was 94.4%(17/18),91.7%(11/12) and 93.3%(28/30) respectively.In benign group, RI1 was 0.16±0.34, RI2 was 0.16±0.36. In malignant group, RI1 was 0.46±0.49, RI2 was 1.41±1.21. The RI1 between benign and malignant group was no significant difference, P＞0.05, but there was statistical significant about RI2, P＜0.05. There was no significant difference in RI1 and RI2 of benign group, P＞0.05, but the difference between RI1 and RI2 of malignant group was statistically significant, P＜0.05.In addition, taking the uptake ratio of 4h delayed phase as indicator, counting positive cases, then calculating the volume of positive nodes, and the average value was 31.54±22.84. Doing pearson correlation analysis for DR2 and V of positive nodes. There is a positive relationship between them, and r= 0.923, p= 0.000.[Conclusion] As a non-specific pro-tumor imaging agent,99Tcm-HL91 have some clinical value for the differential diagnosis of thyroid cold nodules; Comparing semi-quantitative analysis and qualitative analysis, the former is more accurate in detecting the nature of nodules; 4h delayed phase can enhance the sensitivity, accuracy and specificity than 2h delayed phase; the degree of hypoxia and the size of tumor are correlated. |
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