超声、CT与^(99)Tc^m-MIBI核素扫描在原发性甲状旁腺功能亢进症中的诊断价值比较及其漏诊原因分析

Comparative Study and False Negative Cases Analysis of Preoperative Ultrasonography,^(99)Tc^m-Sestamibi Scintigraphy,and CT in Primary Hyperparathyroidism

目的探讨超声、CT与99Tcm-甲氧基异丁基异腈(MIBI)核素扫描在原发性甲状旁腺功能亢进症(PHPT)中的诊断价值及其漏诊原因。方法回顾性分析中国医科大学附属盛京医院普外科2003年1月至2012年8月期间行手术治疗的69例PHPT患者的临床资料。结果术后经病理学检查证实,69例患者共76个病灶,其中甲状旁腺腺瘤58例(60个病灶),甲状旁腺增生7例(11个病灶),甲状旁腺腺癌4例(5个病灶)。超声、CT与99Tcm-MIBI核素扫描的灵敏度分别为81.94%(59/72)、61.76%(21/34)及69.57%(16/23),准确性分别为78.67%(59/75)、61.76%(21/34)及66.67%(16/24);阳性预测值分别为95.16%(59/62)、100%(21/21)及94.12%(16/17)。仅超声与CT灵敏度的差异有统计学意义(P=0.03),3种检查的其他相应指标比较差异均无统计学意义(P>0.05)。结论超声与99Tcm-MIBI核素扫描互补,而CT对诊断甲状旁腺病灶的帮助不大,推荐术前常规行超声与99Tcm-MIBI核素扫描两项检查。

Objective To evaluate the diagnostic significance and to analyze reasons of false negative cases for preoperative ultrasonography, 99Tcm-sestamibi scintigraphy （MIBI scintigraphy）, and CT in primary hyperparathyroidism （PHPT）. Methods Clinical data of 69 patients with PHPT, who underwent operation in Affiliated Shengjing Hospital of China Medical University between Jan. 2003 and Aug. 2012 were retrospectively analyzed. Results There were 76 parathyroid lesions in 69 PHPT patients proved by operation and pathology, including 58 cases of parathyroid adenoma with 60 lesions, 7 cases of parathyroid hyperplasia with 11 lesions, and 4 cases of parathyroid carcinoma with 5 lesions. The sensitivity ofultrasonography, CT, and 99Tcm-MIBI scintigraphy were 81.94% （59/72）, 61.76% （21/34）, and 69. 57% （16/23）, the accuracy of 3 kinds of tests were 78.67% （59/75）, 61.76% （21/34）, and 66. 67% （16/24）, the positive predictive value were 95. 16% （59/62）, 100% （21/21）, and 94. 12% （16/17） respectively. There was significant differ- ence only between ultrasonography and CT in sensitivity （P--0. 03）, no other significant difference was found （P〉0.05）. Conclusions Ultrasonography is complementary to 99Tcm-MIBI scintigraphy, but CT has little significance in diagnosis of PHPT. Both of ultrasonography and 99Tcm-MIBI scintigraphy should be used before operation routinely to localize parathyroid lesions.