^99mTc-MIBI双时相法诊断甲状旁腺功能亢进症的临床价值

Clinical Value of Double-phase ^(99m)Tc-MIBI Scintigraphy in the Diagnosis of Hyperparathyroidism

目的探讨核素99mTc-甲氧基异丁基异腈(99mTc-MIBI)双时相法显像在诊断甲状旁腺功能亢进症(hyper-parathyroidism,HPT)中的作用,并与其他影像检查方法进行比较。方法65例临床考虑为HPT的患者均分别进行了核素显像及超声检查,20例做了CT检查,11例做了MRI检查。核素显像采用99mTc-MIBI双时相法。比较几种影像检查的灵敏度、特异性,分析其对HPT的诊断价值。结果65例患者中,甲状旁腺激素(PTH)增高36例,以PTH结果为诊断标准。核素检查阳性34例,阴性2例,灵敏度94.4%,特异性100%,准确性96.9%;超声检出32例,阴性4例,假阳性2例,其灵敏度88.9%,特异性93.1%,准确性90.8%;CT阳性17例,MRI阳性8例。结论核素99mTc-MIBI双时相法甲状旁腺显像是一种简便有效的检查方法,可提高甲状旁腺瘤术前定位诊断的准确率。临床高度怀疑原发性甲状旁腺功能亢进症的病人,若超声检查阴性应进一步行核素检查除外甲状旁腺瘤。

Objective To compare double phase ^99mTc-MIBI imaging with ultra-sound, CT and MRI in the diagnosis of hyperparathyroidism. Methods Sixty-five patients with clinical diagnosis of hyperparathyroidism were injected intravenously with 370 MBq（ 10 mCi） of ^99mTc-MIBI, and imaged 15 min later as early phase imaging and 120 min later as delayed phase imaging respectively. All patients under went B ultra-sound examination ; 20 and 11 patients underwent CT and MRI, respectively. Results Thirty-six cases among 65 patients showed high level of parathyroid homone （PTH）, which was considered as diagnostic criterion for hyperparathyroidism. Among these, 34 showed positive radionuclide parathyroid images, with the sensitivity, specificity and accuracy of 94.4%, 100% and 96.9%, respectively. Thirty-two patients showed abnormal ultra-sound results, and the sensitivity, specificity and accuracy were 88.9%, 93.1% and 90.8%, respectively. Seventeen CT images and 8 MR images showed positive results, respectively. Thirty-five adenomas and 1 histo-pathologically proved hyperplastic gland were removed from 34 patients. Conclusion Double phase^99mTc-MIBI imaging is a kind of useful and reliable approach for localization of parathyroid adenomas. Combined with other examinations, double phase ^99mTc-MIBI imaging can improve the accuracy of diagnosis of the parathyroid lesions before surgery.