甲状旁腺99Tcm-MIBI SPECT/CT显像在原发性甲状旁腺功能亢进症术前诊断中的增益价值

摘要

Objective To investigate the incremental value of 99Tcm-MIBI SPECT/CT imaging in the preoperative diagnosis of PHPT.Methods Forty-one patients (13 males,28 females,age range:14-82 (50.0± 13.2) years)with PHPT were retrospectively enrolled.99Tcm-MIBI dual-phase planar scan,SPECT/CT imaging,CT and neck ultrasound were performed before surgery.All patients had pathological results.McNemarx2 test was used to compare the detection rates of the four imaging methods.ROI method was applied to calculate the uptake ratio (T/NT) and Pearson correlation analysis was used to evaluate correlation between T/NT and serum intact PTH,Ca,the lesion volume measured after parathyroidectomy.Results A total of 42 parathyroid lesions were confirmed by pathology.There were 39 patients with parathyroid adenoma (2 with double adenomas,and 37 with single adenoma containing 2 ectopic adenomas) and 1 patient with parathyroid carcinoma.The detection rate of planar scan,SPECT/CT imaging,CT and neck ultrasound were 78.0％ (32/41),92.7％ (38/41),73.2％ (30/41) and 70.7％ (29/41) respectively.Detection rate of SPECT/CT imaging was significantly higher than that of planar scan,CT or ultrasonography (x2 =4.17,4.90,5.82,all P＜0.01).However there were no remarkable differences between the detection rate of planar scan and that of CT or ultrasonography (x2=0.08,0.36,both P＞0.05).Detection rates of CT and ultrasonography were not significantly different either (x2 =1.90,P＞0.05).T/NT in delayed planar imaging were significantly correlated with PTH,Ca and the lesion volume measured after parathyroidectomy (r =0.56,0.54,0.56,all P＜0.01).Conclusions Compared with 99Tcm-MIBI dual-phase planar scan,CT and ultrasonography,SPECT/CT imaging could be of important clinical value for preoperative localization of PHPT because of its higher detection rate and accurate anatomical localization ability.%目的 探讨甲状旁腺99Tcm-MIBI SPECT/CT显像在PHPT患者术前诊断中的临床增益价值.方法 回顾性分析41例[男13例,女28例,年龄14～ 82(50.0±13.2)岁]临床诊断为PHPT的患者术前99Tcm-MIBI双时相甲状旁腺平面显像、SPECT/CT显像、CT及颈部超声检查结果,采用McNemar检验比较不同方法对甲状旁腺病灶检出率的差异.应用ROI技术计算T/NT值,并用Pearson相关分析探讨其与近期术前PTH、血钙水平以及病灶体积的相关性.结果 41例PHPT患者经手术共发现42个甲状旁腺病灶,病理证实腺瘤39例(单发腺瘤37例,包括2例异位腺瘤;双发腺瘤2例);甲状旁腺癌1例.平面显像、SPECT/CT显像、CT检查、超声对患者病灶的检出率分别为78.0％(32/41)、92.7％(38/41)、73.2％(30/41)和70.7％(29/41).SPECT/CT显像对病灶的检出率明显高于平面显像、CT及超声,二者差异有统计学意义(x2值分别为4.17、4.90、5.82,均P＜0.05).平面显像对病灶的检出率稍高于CT、超声,但差异无统计学意义(x2值分别为0.08、0.36,均P＞0.05),CT与超声对病灶的检出率差异无统计学意义(x2=1.90,P＞0.05).30例PHPT患者延迟相T/NT值与术前PTH、血钙水平及病灶体积有明显的相关性(r=0.56、0.54、0.56,均P＜0.01).结论 与99Tcm-MIBI双时相平面显像、CT及超声检查相比,SPECT/CT显像不仅能够提供更加精确的解剖信息,而且有更高的检出率,对PHPT术前定性定位诊断有重要临床价值.