Cengiz ERÇİN, Ahmet ILGAZLI, Canan ŞENGÜL, Fatma BERK, Füsun YILDIZ, Haşim BOYACI

Toraks içi patolojilerin malign ve benign ayrımında Tc-99m MIBI sintigrafisinin tanı değeri

Çalışmada, teknesyum 99m hexakis 2-methoxyisobutyl isonitryle (Tc-99m MIBI) sintigrafisinin, toraks içi malign ve benign lezyonların değerlendirilmesinde ve ayırıcı tanısında yeri olup olmadığının araştırılması amaçlanmıştır. Kocaeli Üniversitesi Göğüs Hastalıkları Kliniği'ne başvuran ve PA akciğer grafisinde patoloji saptanan, daha önce herhangi bir tedavi görmemiş olan rastgele yöntemle seçilmiş 19'u erkek, 18'i kadın, toplam 37 olgu çalışmaya alınmıştır. Olgulara 15-25 mCi Tc-99m MlBl intravenöz enjeksiyonunu takiben supin pozisyonda erken (10 dakika) ve geç (2.5 saat), anterior ve posterior planar statik görüntüler ile toraks SPECT'i uygulanmıştır. Görüntüler görsel olarak değerlendirilmiştir. Malignite saptanan 18 olgunun; planar görüntülemede 14'ünde, SPECT görüntülemede ise 15'inde sintigrafık olarak anormal aktivite tutulumu saptanmıştır. Benign patolojisi olan 19 olgunun 4'ünde hem planar hem de SPECT görüntülemede anormal aktivite tutulumu saptanmıştır. Akciğer grafisi ve toraks tomografisinde patolojik lezyon saptanan olgularda, Tc-99m MIBI sintigrafisi, malign lezyonların belirlenmesinde %83.3 duyarlılık ue %78.9 özgüllük göstermiştir. Pozitif prediktif değer %78.9, negatif prediktif değer ise %83.3 olarak bulunmuştur. Duyarlılık ve özgüllük değerleri çok yüksek olmamakla birlikte; Tc-99m MIBI sintigrafısi, toraks içi lezyonların malign, benign ayrımında kullanılabilecek, noninvaziv bir tanı yöntemi olabilir. Ancak daha geniş hasta gruplarında çalışılması gereklidir.

Diagnostic value of Tc-99m MIBI scintigraphy in the differential diagnosis of malign and benign of intrathoracic pathologies

This study was conducted to assess the feasibility of using Tc-99m labelled 2-methoxy isobutyl isonitrile (MIBI) scintigraphy, to evaluate benign and malignant intratoracic lesions and to assess the value in the differential diagnosis. The eli-gible population of the study included randomly selected 37 patients examined in Kocaeli University Pulmonary Clinic (19 men, 18 women) who had a abnormality in the PA chest X-ray and hadn't received any therapy. After intravenous injection of 15-25 mCi Tc-99m MIBI, early (10 minutes) and delayed (2.5 hours) static spot images of posterior and anterior tho-rax and SPECT images were obtained. Assessment ofMlBI uptake was done visually. Of the 18 patients with primary bronc-hial carcinoma, increased abnormal uptake of MIBI corresponding to the location of lesion was reported in 14 patients with planar imaging and in 15 patients with SPECT and was considered positive. Three patients had no abnormal activity. Of the 19 patients with benign lesions, four had abnormally increased uptake of MIBl. In the detection of malignant lesions Tc-99m MIBl has 83.3%, 78.9%, 78.9%, and 83.3%, specificity, sensitivity, positive predictive value and negative predictive value respectively. Tc-99m MIBl tumor scintigraphy might be a valuable non-invasive method in the differential diagnosis of malignant and benign lung lesions. However further study with larger series for the relatively low sensitivity and specificity.

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