【摘要】 目的 通过高锝酸钠-单光子发射计算机断层显像/电子计算机X射线断层扫描技术(^99mTcO4-SPECT/CT)核素显像提供甲状腺结节功能状态、结节解剖特点以及超声检查联合血清促甲状腺激素（TSH）水平进一步鉴别诊断甲状腺结节的良恶性，客观评价甲状腺结节的良恶性情况，对甲状腺结节的良恶性做出早期诊断。方法 对因甲状腺结节同时行^99mTcO4-SPECT/CT甲状腺核素显像、甲状腺B超及TSH水平检查的患者共80例（92个结节）进行回顾性分析，对比不同方法及联合检查对甲状腺结节的诊断效能。结果 92个结节中良性74个，恶性18个；^99mTcO4-SPECT/CT甲状腺显像与超声检查比较灵敏度（77.8%）高，特异度（70.2%）及准确度（71.7%）低，假阳性率（29.7%）高，假阴性率（22.2%）低，两者之间灵敏度、特异度、准确度、假阳性率、假阴性率差异均具有统计学意义（P<0.05）;两者准确度比较差异无统计学意义（P>0.05）。^99mTcO4-SPECT/CT甲状腺显像与超声检查比较灵敏度高，特异性及准确度低，假阳性率高，假阴性率低，两者之间灵敏度、特异度、准确度、假阳性率、假阴性率差异均具有统计学意义（P<0.05）;两者准确度比较差异无统计学意义（P>0.05）;^99mTcO4-SPECT/CT甲状腺显像与超声检查联合较单独核素、单独超声检查灵敏度（88.9%）、特异度（87.8%）、准确度（81.5%）高，假阳性率（12.1%）、假阴性率（11.1%）低；联合检查与单独核素特异度、准确度、假阳性率比较差异有统计学意义（P<0.05）,灵敏度与假阴性率比较差异无统计学意义（P>0.05）;联合检查与单独超声灵敏度、准确度、假阴性率比较差异有统计学意义（P<0.05）;特异度与假阳性率比较差异无统计学意义（P>0.05）。结论 超声可以作为甲状腺结节的首选检查方法，其特异性高，但灵敏度低。^99mTcO4-SPECT/CT甲状腺显像在提供功能和代谢信息的同时，能提供解剖信息；而血清TSH水平则可为甲状腺结节的良恶性鉴别提供重要的参考依据，尤其对于核素冷结节且超声实性结节的患者，更应参考其TSH水平，将三者结合起来判断甲状腺结节的性质，为临床提供恰当的治疗方案，这具有重要意义。更多还原

【Abstract】 Objective To differentiate the benign and malignant thyroid nodules by ^99mTcO4-SPECT/CT radionuclide imaging, anatomical features of thyroid nodules, and ultrasound examination combined with thyroid stimulating hormone（TSH） level, so as to objectively evaluate the benign and malignant thyroid nodules and make early diagnosis of benign and malignant thyroid nodules.Methods ^99mTcO4-SPECT/CT thyroid radionuclide imaging, thyroid B-ultrasound and TSH were performed in 80 patients with 92 thyroid nodules in our hospital.The diagnostic efficacy of different methods and combined examinations for thyroid nodules was analyzed retrospectively.Results Among the 92 nodules, 74 were benign and 18 were malignant.^99mTcO4-SPECT/CT thyroid imaging had higher sensitivity（77.8%）,lower specificity（70.2%）,lower accuracy（71.7%）,higher false positive rate（29.7%） and lower false negative rate（22.2%） than ultrasonography.The sensitivity, specificity, accuracy, false positive rate and false negative rate were statistically significant（P<0.05）;There was no significant difference in accuracy（P>0.05）.Compared with ultrasonography, ^99mTcO4-SPECT/CT thyroid imaging had higher sensitivity, lower specificity and accuracy, higher false positive rate and lower false negative rate.There were significant differences in sensitivity, specificity, accuracy, false positive rate and false negative rate between them（P<0.05）;There was no significant difference in accuracy between the two methods（P>0.05）.The sensitivity（88.9%）,specificity（87.8%）,accuracy（81.5%）,false positive rate（12.1%） and false negative rate（11.1%） of thyroid imaging combined with ultrasonography.^99mTcO4-SPECT/CT were higher than those of radionuclide and ultrasonography alone; There was significant difference in specificity, accuracy and false positive rate between combined and single nuclides（P<0.05）,but no significant difference in sensitivity and false negative rate（P>0.05）;There were significant differences in sensitivity, accuracy and false negative rate between combined ultrasound and single ultrasound（P<0.05）;There was no significant difference between specificity and false positive rate（P>0.05）.Conclusion Ultrasound can be used as the first choice for thyroid nodules, with high specificity but low sensitivity.^99mTcO4-SPECT/CT thyroid imaging can provide anatomical information as well as functional and metabolic information; Serum TSH can provide an important reference for the differentiation of benign and malignant thyroid nodules, especially for patients with radionuclide cold nodules and ultrasound solid nodules.It is of great significance to combine the three to judge the nature of thyroid nodules and provide an appropriate clinical treatment plan.更多还原