Objective: To analyze the clinical value of SPECT/CT in diagnosis of skull base bone invasion and clinical decision-making for nasopharyngeal carcinoma (NPC), and to compare their diagnostic value with SPECT/CT, CT, MRI, and MRI combined with SPECT (MRI-SPECT) for skull base bone invasion. Methods: Before treatment, among 348 newly diagnosed NPC patients, CT scan was performed in 186 patients (group A) and the remaining 162 patients received MRI scan (group B). Clinical doctors then made clinical management decisions according to the CT or MRI results. After that, all patients underwent (99)Tc(m)-MDP SPECT/CT examination for nasopharyngeal local tomography, and the results were provided to the clinical doctors to make clinical management decisions again. The changes between the two clinical management decisions were scored according to diagnosis, range of lesion, staging, treatment regimens, and auxiliary examination. The diagnostic value of CT scan, MRI scan, SPECT/CT and MRI-SPECT for skull base bone invasion was then evaluated and compared. Results: In terms of changes in scores of clinical management decisions, the score of group A was 1.387 and group B was 0.951, showing a significant difference between the two groups by Wilcoxon test (Z=6.570, P<0.001). By χ(2) test, there were correlations between CT and SPECT/CT (χ(2) =98.495, P<0.001), and between MRI and SPECT/CT (χ(2) =32.662, P<0.001). The consistency of CT and SPECT/CT (Kappa=0.713) was greater than MRI and SPECT (Kappa=0.449). The sensitivity of CT, MRI, SPECT/CT and MRI-SPECT was 67.1%, 84.5%, 90.8% and 100%, the specificity was 73.3%, 92.3%, 85.6% and 84.6%, and the area under the ROC curve was 0.702, 0.884, 0.882 and 0.923, respectively. Conclusions: SPECT/CT has important impact on clinical management decision for NPC. In the judgement of skull base invasion, the diagnostic value of SPECT/CT is significantly higher than CT and approximately equal to MRI. SPECT/CT should be one of the routine examination methods of nasopharyngeal carcinoma. In addition, in view of its greater diagnostic value, MRI combined with SPECT should be the focus of future imaging studies.
目的： 探讨单光子发射计算机断层摄影术(SPECT)/CT对颅底骨侵犯的诊断价值及对鼻咽癌临床决策的影响。 方法： 348例鼻咽癌初诊患者中，186例治疗前行CT检查(A组)，162例治疗前行磁共振成像(MRI)检查(B组)，临床医师按照CT或MRI的检查结果进行临床决策。然后全部患者再行鼻咽部(99)Tc(m)-亚甲基二膦酸盐(MDP) SPECT/CT局部断层扫描，临床医师结合前后所有检查结果再一次做出临床决策。对前后临床决策的变动(诊断、病灶范围、分期、治疗方案、辅助检查)进行评分。将各项检查的诊断结果与定性结果加以比较，评价CT、MRI、SPECT/CT以及MRI-SPECT诊断颅底骨侵犯的价值。 结果： A组平均临床决策变动评分1.387分，B组0.951分，差异有统计学意义(Z＝6.570，P<0.001)。SPECT/CT的诊断结果与CT、MRI的诊断结果有关(χ(2)＝98.495，P<0.001; χ(2)＝32.662，P<0.001)，其中SPECT/CT诊断结果与CT诊断结果的一致性(Kappa＝0.713)高于SPECT/CT诊断结果与MRI诊断结果的一致性(Kappa＝0.449)。CT、MRI、SPECT/CT和MRI-SPECT诊断颅底骨侵犯的敏感度分别为67.1%、84.5%、90.8%和100.0%，特异度分别为73.3%、92.3%、85.6%和84.6%，受试者工作特征曲线下面积分别为0.702、0.884、0.882和0.923。 结论： SPECT/CT检查对鼻咽癌的临床决策有重要影响。在判断颅底骨侵犯方面，SPECT/CT的诊断价值高于CT，而与MRI大致相同。SPECT/CT应该成为鼻咽癌的常规检查方法之一。MRI联合SPECT表现出更高的诊断价值，应该成为未来影像学研究的重点。.
Keywords: (99)Tc(m)-MDP; Diagnosis; Nasopharyngeal neoplasms; Neoplasm invasion; Skull base; Tomography, emission-computed, single-photon.