骨型原发甲状旁腺机能亢进影像表现

Imaging findings of bone disease caused by primary hyperparathyroidism

目的分析骨型原发甲状旁腺机能亢进(primary hyperparathyroidism,PHPT原发性甲旁亢)的影像表现,复习相关的病理以提高临床对该病的认识。方法回顾性分析经临床手术病理证实的29例骨型PHPT术前影像资料(包括平片、B型超声、CT、ECT、BMD等),并结合临床和病理加以分析。结果29例骨型PHPT中甲状旁腺瘤28例,甲状腺癌1例,其中右侧15例,左侧14例。全身骨骼累计受累13处,最少1处,最多7处。入院前影像诊断涉及骨病种5类,病理骨折9例,多发骨囊性变6例,多发骨质疏松5例,骨巨细胞瘤4例,恶性肿瘤3例;另四肢乏力体重下降无X线影像资料2例。双手X线摄片12例,11/12示第二、三指骨桡侧出现骨膜下骨吸收。ECT(同位素全身骨扫描)受检者20例,17例呈骨代谢异常表现,颅骨普遍放射性浓聚6例,胸骨领带征6例,肋骨串珠征6例,并全身放射性摄取量普遍增加。入院后颈部B型超声14例,13/14例发现甲状旁腺占位,1/14例阴性。CT检查14/14例均发现甲状旁腺占位。ECT甲状旁腺双时相显相法:受检患者20例,2 h延时后16/20例甲状旁腺异常显相,4/20例无阳性所见。结论骨型PHPT临床表现复杂且骨骼改变复杂多样,当患者出现多骨骼病变并伴有全身不明原因的骨质疏松,尤与年龄不符的骨质疏松时应首先想到此病并做全面检查包括甲状旁腺检查,血液生化检查等。忽视全身情况仅限于局部的影像检查会造成该病的误诊、漏诊甚至错误治疗。

Objective To recognize imaging findings and correlated pathology of bone disease caused by primary hyperparathyroidism and to improve the knowledge of this disease by review correlated pathology. Methods Preoperative imaging, clinical and pathologic data of 29 patients of hyperthyroidism were reviewed, which were confirmed by pathology. The imaging data included plain film, uhrasonography, CT, ECT, BMD. Results 28 of 59 hyperparathyroidism patients were trouble with parathyroid adenoma, one was troubled with parathyroid carcinoma. 15 of 29 patients were in the right side, 14 were in the left side. The total of involved location of whole body bone were 13, the least was one, the most was 7. The clinical manifestation could be classified as 6 kinds： 9 pathologic fractures, 6 multiple cystic leasions, 5 multiple osteoporosis, 4 giant cell tumor of bone, 3 malignant tumors, 2 hypodynamia and weight loss. 12 cases were performed X-ray of both hand, 11 of 12 patients were present subperiosteal resorption of the second and third finger. 20 patients were performed ECT（emission computed tomography）, 17 of 20 patients were present abnormality of bone metabolism, 6 cases increased tracer accumulation diffusely, 6 cases were present bow tie sign of sternum, 6 cases were present beading sign of ribs. 14 patients were performed uhrasonography of neck in hospital, 13 cases were found masses of parathyroid gland, 1 was negative. 14 patients were performed CT, all of the patients were found masses of parathyroid gland. 20 patients were performed Parathyroid dural phase exam of ECT, 16 cases increased tracer accumulation of parathyroid gland on delayed 2 hours, 4 cases were nagative. Conclusions Clinical manifestation and bone changes of bone disease caused by primary hyperparathyroidism were complicated and variety. When patient appeared multiple bone resorption and destruction, accompanied whole body osteoporosis, we should think this disease and perform various examination, including parathyroid gland, blood, biochemistry examination, et al. If you overlook whole body condition and focus on local bone X-ray findings, you could be give a misdiagnosis, missed diagnosis, even undertake error treatment.