^(99m)Tc-MIBI SPECT/CT对原发性甲状旁腺功能亢进症的诊断价值

Value of ^(99m)Tc-MIBI SPECT/CT in diagnosis of primary hyperparathyroidism

目的探讨99m锝-甲氧基异丁基异腈(99mTc-MIBI)和单光子发射型计算机断层显像/计算机断层扫描(SPECT/CT)对原发性甲状旁腺功能亢进症(PHPT)病灶的诊断价值。方法 PHPT患者37例,静脉注射99mTc-MIBI 740 MBq,分别于注射后30 min及2～3 h进行颈胸部早期相和延迟相平面显像,延迟平面显像后行颈胸部99mTc-MIBI SPECT/CT同机融合显像。显像结果与术后病理结果相比较,采用McNemar检验,并结合患者的临床表现及实验室指标进行统计分析。结果术后病理确定37例PHPT患者共有41个甲状旁腺病灶,其中29例为单发甲状旁腺腺瘤(包括5例异位甲状旁腺腺瘤),2例各有两个甲状旁腺腺瘤,5例为单发甲状旁腺增生,另1例为3个甲状旁腺增生。99mTc-MIBI SPECT/CT融合显像对PHPT的病灶检出率为87.8%,显著高于99mTc-MIBI双时相平面显像75.6%的检出率(P<0.05)。对甲状旁腺增生灶,99mTc-MIBI SPECT/CT的诊断灵敏度为50.0%,而平面显像均未检出病灶(P<0.05)。此外,99mTc-MIBI SPECT/CT融合显像可提供病灶的解剖位置,尤其方便异位PHPT病灶的定位或术中探查。结论 99mTc-MIBI SPECT/CT是探查PHPT病灶的有效诊断方法,综合临床价值高于99mTc-MIBI双时相平面显像。

Objective To investigate the value of 99mTc-sestamibi(99mTc-MIBI) and single photon emission computed tomography/computerized tomography(SPECT/CT) in diagnosis of primary hyperparathyroidism(PHPT). MethodsThirty-seven patients with PHPT were selected.Thirty minutes(early phase) and two hours(delayed phase) after intravenous administration of 99mTc-MIBI(740 MBq),dual-phase planar imaging over the neck and chest was performed,followed by SPECT/CT imaging.The imaging findings were compared to the pathological results.Statistical analysis was conducted on the basis of clinical manifestations and laboratory findings with McNemar test. ResultsIn total,41 parathyroid lesions from 37 patients with PHPT were confirmed by pathology.Among the 37 patients,29 patients had single parathyroid adenoma(ectopic parathyroid adenoma in 5 patients),5 patients had single parathyroid hyperplasia lesion,2 patients had 2 parathyroid adenomas,and the other patient had 3 parathyroid hyperplasia lesions.99mTc-MIBI SPECT/CT identified 87.8% of the PHPT lesions,with significantly higher diagnostic sensitivity than that of 99mTc-MIBI dual-phase planar imaging(75.6%)(P<0.05).The sensitivity of 99mTc-MIBI SPECT/CT in diagnosis of parathyroid hyperplasia lesions was 50.0%,while no parathyroid hyperplasia lesion was detected by planar imaging(P<0.05).SPECT/CT also provided exact anatomical locations of the lesions,which was especially helpful for the surgical treatment of ectopic PHPT lesions. Conclusion99mTc-MIBI SPECT/CT is more effective than conventional 99mTc-MIBI dual-phase planar imaging in diagnosis of PHPT.