^(99)Tc^m-MIBI双时相显像定位诊断原发性甲状旁腺机能亢进症的价值

Value of ^(99)Tc^m-MIBI double-phase imaging on anatomical diagnosis of primary hyperparathyroidism

目的:评价99Tcm-甲氧基异丁基异腈(MIBI)双时相显像对原发性甲状旁腺机能亢进症(PHPT)定位诊断的价值。方法:对15例正常对照者和51例临床表现及生化检查提示原发性甲状旁腺机能亢进的患者,行99Tcm-MIBI双时相甲状旁腺平面显像(患组于术前1周内安排检查),部分患者安排SPECT断层显像,同时采用ROI技术计算摄取比值。结果:①与手术结果对比,99Tcm-MIBI双时相甲状旁腺显像在早期相和延迟相对腺瘤的诊断灵敏度分别为78.3%(36/46)和91.3%(42/46),对增生灶的诊断灵敏度分别为23.8%(5/21)和47.6%(10/21)。有6个病灶通过SPECT断层显像得以确诊(包括1个异位腺瘤病灶)。②术后证实甲状旁腺病灶重量大于1500mg者99Tcm-MIBI双时相显像均为阳性,小于500mg者均为阴性,重量在500￣1500mg者阳性率为82.4%。③阳性腺瘤组摄取比值,延迟相明显高于早期相(P<0.01),两个时相均明显高于正常对照组(P<0.01)。结论:99Tcm-MIBI双时相显像对于定位诊断PHPT具有较高的临床价值,摄取比值测定和断层显像有利于提高阳性诊断率。

Objective：To evaluate the clinical value of ^99Tc^m-MIBI double-phase imaging on anatomical diagnosis of primary hyperparathyroidism （PHPT）.Methods：Double phase ^99Tc^m-MIBI imaging was performed in 15 normal controls and 51 patients with primary hyperparathyroidism proven by physical examination and biochemical blood tests （for the latter group,the examination was performed in 1 week before the operation）.Tomographic scanner was arranged for part of the patients.The uptake ratio was calculated and compared by ROI sequence.Results：Comparing the imaging results with those of histopathology, the sensitivity percentages of early and delayed phases to parathyroid adenomas were 78.3%（36/46）and 91.3%（42/46）,and those to parathyroid hyperplasia were 23.8%（5/21）and 47.6%（10/21）respectively.Six lesions of parathyroid were demonstrated by SPECT tomographic imaging.The positive rate of lesions （weighting between 500 to 1500 mg）was 82.4%,and all lesions over 1500 mg appeared to be positive,those less than 500mg appeared to be negative in ^99Tc^m-MIBI double-phase imaging.For positive parathyroid adenoma group,the uptake ratio of delayed phase was significant higher than that of early phase（P〈0.01）, and the ratio of both phases were significant higher than that of the normal controls （P 〈0.01）.Conclusion：99Tcm-MIBI double-phase imaging had higher clinical value on anatomical diagnosis of PHPT,and the measurement of uptake ratio and tomographic imaging were beneficial for improving the positive diagnosis rate.