99mTc—MIBISPECT／CT对原发性甲状旁腺功能亢进症的术前定位诊断价值

Value of 99mTc-MIBI SPECT/CT on preoperative localization diagnosis of primary hyperparathy- roidism

目的探讨“锝-甲氧基异丁基异腈（99mTc．MIBI）单光子发射型计算机断层显像／计算机断层扫描（SPECT／CT）双时相显像对原发性甲状旁腺功能亢进症（pHPT）的术前定位诊断价值，并与超声检查比较。方法58例经病理证实的pHPT患者术前均行99mTc—MIBISPECT／CT双时相甲状旁腺显像及颈部超声检查，将检查结果与手术及病理结果比较，同时伴随的甲状腺病理结果也被记录。采用配对x。检验，比较两种检查方法对甲状旁腺病灶的检出率。结果术后病理证实58例p／-IPT患者共有78枚甲状旁腺病灶，其中腺瘤47枚（包括2枚异位腺瘤），增生28枚，腺癌3枚99mTc—MIBISPECT／CT对pHPT病灶的总的检出率为79．5％，明显高于超声的检出率（62．8％），x2=7．579，P〈0．05。伴有甲状腺疾病的17例患者中，99mTc—MIBISPECT／CT和超声对甲状旁腺病灶的检出率分别为71．4％和46．4％，二者比较差异有统计学意义（x2=4．000，P〈0．05）。而对于不伴有甲状腺疾病的41例pHPT患者MIBI和超声对甲状旁腺病灶的检出率分别为92．0％，78．0％，二者比较差异无统计学意义（X2=3．273，P〉0．05）。结论99mTc-MIBISPECT／CT是定位pHPT病灶的有效方法，对于伴有甲状腺疾病的pHPT及异位的甲状旁腺病灶，其定位价值高于超声。

Objective To evaluate the preoperative localization value of 99mTc-sestamibi （99mTc- MIBI） single photon emission computed tomography/computerized tomography （SPECT/CT） dual-phase imaging on patients with primary hyperparathyroidism （pHPT） , and was compare with neck ultrasound （US）. Methods 99mTc-MIBI SPECT/CT dual-phase imaging and neck ultrasound were performed pre- operatively in 58 patients with pHPT confirmed by the operative and pathological results. Concomitant pathology. The imaging findings were compared with thyroid pathology was also recorded. The paired chi- square test was used to compare the detection rate between the two imaging techniques. Results Fifty- eight patients were diagnosed pathologically with a total of 78 parathyroid lesions, there were 47 adenomas （including two ectopic adenomas ） , 28 hyperplasia lesions and 3 parathyroid carcinomas. 99mTc-MIBI SPECT/CT identified 79.5% of the pHPT lesions, with significantly higher detection rate than that of US （62.8%）, X2= 7. 579, P 〈 0.05. MIBI and US identified the parathyroid pathology in 71.4% and 46.4% in the concomitant thyroid disease group of 17 patients, respectively, and in 92. 0% and 78.0% in the non-concomitant thyroid disease group of 41 patients, respectively. Significant differences were found in the concomitant thyroid disease group （ X2 = 4. 000, P 〈 0. 05 ） and were not found in the non-concomi- tant thyroid disease group（X2 = 3. 273 ,P 〉 0. 05 ）. Conclusions 99mTc-MIBI SPECT/CT is more effec- tive than US in locating pHPT lesions that are concomitant thyroid disease and ectopic.