MRI弥散加权成像、甲状腺摄碘率和血清指标测定鉴别Graves甲状腺功能亢进症和无痛性甲状腺炎的研究

Differentiation between Graves disease and painless thyroiditis by diffusion-weighted imaging, thyroid radioactive iodine uptake and serum parameters measurement

    摘要
  • 摘要:
    目的 研究MRI弥散加权成像（DWI）的表观弥散系数（ADC）、甲状腺摄131I率（RAIU）和血清指标等在Graves甲状腺功能亢进症（简称甲亢）和无痛性甲状腺炎（PT）鉴别中的价值。
    方法 选取102例Graves甲亢患者和37例PT患者入组。测定所有患者的血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、TSH、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）和促甲状腺激素受体抗体（TRAb）水平。采用3.0T超导型MRI仪完成MRI检查，并获得ADC。测定甲状腺24 h RAIU，并进行甲状腺静态显像。Graves甲亢患者的病理组织从接受手术的患者中获取（6例），PT患者的病理组织从接受活检的患者中获取（2例）。采用Pearson检验明确各指标间的相关性，用受试者工作特征曲线（ROC）分析各项指标的诊断价值，确定各项指标的切分点值，并判断各项指标的诊断灵敏度、特异度、准确率、阳性预测值和阴性预测值。
    结果 与PT患者比较，Graves甲亢患者的ADC、TRAb和RAIU显著升高（t=15.126、7.226和31.574，P均＜0.01）。ADC、TRAb和RAIU之间存在显著的正相关性。ROC显示，RAIU、ADC和TRAb的曲线下面积大于0.900。其中，RAIU具有最好的诊断价值，当最佳切分点值确定为24.500%时，灵敏度、特异度、准确率、阳性预测值和阴性预测值均为100%。ADC比TRAb的诊断价值更高，当最佳切分点值分别确定为1.837×10-3 mm2/s和1.350 IU/ml时，ADC的上述统计指标分别为96.078%、91.892%、95.000 %、97.059 %和89.474 %，TRAb的上述统计指标分别为88.235%、75.676%、84.892%、90.909%和70.000%。病理组织学结果显示：Graves甲亢以滤泡增生、滤泡上皮细胞增生以及血管扩张和充血为主要表现；PT以淋巴细胞浸润、淋巴滤泡形成以及滤泡破坏为主要表现。
    结论 对于Graves甲亢和PT的鉴别，RAIU、ADC和TRAb均有价值，RAIU最佳、ADC次之。ADC的显像原理是基于不同疾病细胞密度差异的病生理变化，而RAIU的测定原理是反映不同疾病对碘摄取能力差异的病生理变化。

     

    Abstract:
    Objective To assess the value of apparent diffusion coefficient(ADC) in diffusion-weighted imaging(DWI), thyroid radioactive iodine uptake(RAIU)and serum parameters in differential diagnosis between Graves disease(GD)and painless thyroiditis(PT).
    Methods One hundred and two patients with GD and 37 patients with PT were enrolled. Serum thyroid hormones and antibodies were measured, including free triiodothyronine(FT3), free thyroxine(FT4), TSH, thyroid globulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and thyrotropin receptor antibody(TRAb). DWI was obtained with a 3.0 T MR scanner, and ADC values were calculated. 24 h later RAIU and thyroid scintigraphy were conducted. Tissue samples were obtained in GD patients(6 cases) after thyroidectomy and in PT patients(2 cases) after biopsy. Pearson bivariate correlation was made. Receiver operating characteristic curves(ROC) were drawn and diagnostic efficacies were determined. Optimal cut-off values were selected, and then sensitivity, specificity, accuracy, positive predictive value and negative predictive value were assessed.
    Results ADC, TRAb and RAIU were significantly higher in GD than in PT(t=15.126, 7.226 and 31.574, with all P < 0.01). And they were closely and positively correlated. ROC showed areas under the curves for RAIU, ADC and TRAb were higher than 0.900. RAIU was the best method to differentiate GD from PT. When cutoff value of RAIU was determined as 24.500 %, sensitivity, specificity, accuracy, positive predictive value and negative predictive value were all 100%. The above statistical data were 96.078%, 91.892%, 95.000%, 97.059% and 89.474% for ADC, and 88.235%, 75.676%, 84.892%, 90.909% and 70.000% for TRAb, when the optimal thresholds of 1.837×10-3 mm2/s and 1.350 IU/ml were determined respectively. ADC was better than TRAb. Histopathology results showed that for GD, follicle hyperplasia, follicular epithelial cells hyperplasia, hyper-vascularity and congestive perfusion were characteristic features; while for PT, massive lymphocytic infiltration with hyperplastic germinal center formation and follicle disruption were characteristic features.
    Conclusions RAIU, DWI and TRAb were all of diagnostic values for differentiation between GD and PT, RAIU was the best method and DWI followed. DWI has great potential for thyroid pathophysiological imaging because it reflects tissue cellularity differences between GD and PT. The principle for RAIU is that it reflects the iodine uptake changes in different diseases.

     

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