25例血清PTH升高的甲状旁腺相关疾病患者的诊断

Nuclear medicine diagnostic experience for 25 patients with parathyroid disease accompanied elevated serum PTH level

目的 探讨血清甲状旁腺激素（PTH）升高的甲状旁腺相关疾病的核医学诊断方法和体会.方法 对25例甲状旁腺相关疾病患者进行99Tcm-MIBI SPECT双时相法甲状旁腺显像及99Tcm-亚甲基二膦酸盐（99Tcm-MDP）全身骨静态显像法显像,同时测定血清PTH和血清钙、磷及碱性磷酸酶含量.结果 ①原发性甲状旁腺功能亢进（PHPT）和继发性甲状旁腺功能亢进（SHPT）者血清PTH水平呈不同程度升高,其中PHPT较明显.②PHPT和SHPT患者手术前后PTH水平的变化明显,t分别为6.24和6.85,P均＜0.01;③PHPT患者全身骨显像常呈典型的代谢性骨病骨显像特点,甲状旁腺99Tcm-MIBI双时相显影阳性率为90%以上;④SHPT患者全身骨显像表现多样,常因血本底偏高,骨/组织放射性计数值降低,使骨显像的清晰度受到影响,但通常以骨摄取显像剂增多为主.99Tcm-MIBI双时相甲状旁腺显像多有不同程度的甲状旁腺增生,达56%以上.结论 甲状旁腺、全身骨SPECT检查结合血清PTH水平测定的方法对甲状旁腺相关疾病的诊断及指导治疗具有很高的临床应用价值.

Objective To explore nuclear medicine diagnostic method for parathyroid disease accompanied elevated serum parathyroid hormone （ PTH ） level. Methods The images of 25 patients with parathyroid disease were obtained by SPECT 99Tcm-MIBI double-phase parathyroid imaging and 99Tcm-methylene diphosphonate（99Tcm-MDP） whole-body static bone imaging. All subject were measured serum PTH,calcium, phosphorus and alkaline phosphatase. Results ①Serum PTH level increased to varying degrees in patients with primary hyperparathyroidism（PHPT）, secondary hyperparathyroidism（SHPT）. ②PHPT and SHPT showed significant change before and after surgery （t=6.24 and t=6.85, P〈0.01）. ③The whole-body static bone images of PHPT patients were characterized by metabolic bone disease images. The ositive rates of 99Tcm-MIBI were above 90%. ④Whole-body bone imaging results of SHPT patients showed complex and diverse caused by high background, increased uptakes mainly. 99Tcm-MIBI dual-phase parathyroid imaging showed hyperparathyroidism in varying egree, up to 56% or more. Conclusion Determination of serum PTH combined SPECT for parathyroid and whole-body bone imaging howed high clinical value in diagnosis and treatment of parathyroid disease.