99mTc-MIBI SPECT/CT对原发性甲状旁腺功能亢进症的术前定位诊断价值

摘要

目的 探讨99m锝-甲氧基异丁基异腈(99mTc-MIBI)单光子发射型计算机断层显像/计算机断层扫描(SPECT/CT)双时相显像对原发性甲状旁腺功能亢进症(pHPT)的术前定位诊断价值,并与超声检查比较.方法 58例经病理证实的pHPT患者术前均行99mTc-MIBI SPECT/CT双时相甲状旁腺显像及颈部超声检查,将检查结果与手术及病理结果比较,同时伴随的甲状腺病理结果也被记录.采用配对x2检验,比较两种检查方法对甲状旁腺病灶的检出率.结果 术后病理证实58例pHPT患者共有78枚甲状旁腺病灶,其中腺瘤47枚(包括2枚异位腺瘤),增生28枚,腺癌3枚.99mTc-MIBI SPECT/CT对pHPT病灶的总的检出率为79.5％,明显高于超声的检出率(62.8％),x2 =7.579,P＜0.05.伴有甲状腺疾病的17例患者中,99mTc-MIBI SPECT/CT和超声对甲状旁腺病灶的检出率分别为71.4％和46.4％,二者比较差异有统计学意义(x2=4.000,P＜0.05).而对于不伴有甲状腺疾病的41例pHPT患者MIBI和超声对甲状旁腺病灶的检出率分别为92.0％,78.0％,二者比较差异无统计学意义(x2=3.273,P＞0.05).结论 99mTc-MIBI SPECT/CT是定位pHPT病灶的有效方法,对于伴有甲状腺疾病的pHPT及异位的甲状旁腺病灶,其定位价值高于超声.%Objective To evaluate the preoperative localization value of 99mTc-sestamibi (99mTc-MIBI) single photon emission computed tomography/computerized tomography (SPECT/CT) dual-phase imaging on patients with primary hyperparathyroidism (pHPT),and was compare with neck ultrasound (US).Methods 99mTc-MIBI SPECT/CT dual-phase imaging and neck ultrasound were performed preoperatively in 58 patients with pHPT confirmed by pathology.The imaging findings were compared with the operative and pathological results.Concomitant thyroid pathology was also recorded.The paired chisquare test was used to compare the detection rate between the two imaging techniques.Results Fiftyeight patients were diagnosed pathologically with a total of 78 parathyroid lesions,there were 47 adenomas (including two ectopic adenomas),28 hyperplasia lesions and 3 parathyroid carcinomas.99mTc-MIBI SPECT/CT identified 79.5％ of the pHPT lesions,with significantly higher detection rate than that of US (62.8％),x2 =7.579,P ＜ 0.05.MIBI and US identified the parathyroid pathology in 71.4％ and 46.4％ in the concomitant thyroid disease group of 17 patients,respectively,and in 92.0％ and 78.0％ in the non-concomitant thyroid disease group of 41 patients,respectively.Significant differences were found in the concomitant thyroid disease group (x2 =4.000,P ＜ 0.05) and were not found in the non-concomitant thyroid disease group(x2 =3.273,P ＞0.05).Conclusions 99mTc-MIBI SPECT/CT is more effective than US in locating pHPT lesions that are concomitant thyroid disease and ectopic.