^(99)Tc^m-MIBI和^(99)Tc^mO_4^-显像定位诊断甲状旁腺机能亢进

Localization of hyperfunctional parathyroid glands using ^(99)Tc^m-MIBI and 99TcmO_4 ^-

目的评价99TcmMIBI双时相显像及99TcmMIBI/99TcmO-4联合显像对探测功能亢进甲状旁腺组织的临床应用价值,并与其他影像学手段进行比较。方法68例诊断或疑诊甲旁亢患者行99TcmMIBI甲状旁腺双时相显像(其中9例在一周内行99TcmO-4甲状腺显像),患者均行全身显像,其中1例行SPECT/CT融合显像,35例行B超检查,6例行CT检查。54例行手术治疗获得病理结果(甲状旁腺增生18例,甲状旁腺腺瘤25例,甲状旁腺癌7例,结节性甲状腺肿2例,甲状腺癌1例,淋巴结慢性炎症1例),其余14例临床最终除外甲旁亢。结果99TcmMIBI双时相显像阳性47例,阴性21例;99TcmMIBI/99TcmO-4联合显像阳性8例,阴性1例。核素显像经病理及临床其他检查证实真阳性47例,真阴性15例,假阳性3例,假阴性3例。灵敏度94%,特异性83.3%,准确性91.2%,阳性预测值94%,阴性预测值83.3%。结论综合运用99TcmMIBI的双时相显像、全身显像、SPECT/CT融合显像及99TcmO-4显像能进一步提高核医学对功能亢进甲状旁腺组织定性及定位诊断的准确性。

Objective To evaluate the clinical values of localizing of hyperfunctional parathyroid glands using ^99Tc^m-MIBI double-phase imaging and ^99Tc^m-MIBI/^99Tc^mO4^- imaging. Methods Sixty-eight cases of diagnostic or suspicious hyperparathyroidism underwent ^99Tc^m-MIBI double-phase imaging （9 cases of them underwent ^99Tc^mO4^- imaging within a week）, all of them underwent whole body imaging and 1 case of them underwent SPECT fusion imaging, 6 cases underwent CT, 35 cases underwent neck ultrasonography. Subsequent surgical and pathological results were obtained in 54 cases （18 cases with hyperplasia, 25 cases with adenoma, 7 cases with carcinoma, 1 case with thyroid carcinoma, 2 cases with nodular goitre, 1 case with chronic lymphadenitis）, the other 14 cases were excepted hyperparathyroidism by clinic and pathological results. Results Forty-seven true positive cases, 15 true negative cases, 3 false positive cases and 3 false negative cases were validated by radionuclide parathyroid gland imaging. Then, the sensitivity of 94%, the specificity of 83. 3%, the accuracy of 91.2 %, the positive predictive value of 94 % and the negative predictive value of 83.3 % were obtained. Conclusion 99 Tcm_ MIBI double-phase static imaging at neck and chest, ^99Tc^m-MIBI whole body imaging and SPECT fusion imaging combined with 99 TcmO4 imaging, will raise the accuracy for localization of hyperparathyroidism.