^99Tc^m—MIBI双时相显像定位诊断继发性甲状旁腺功能亢进症的价值

Value of dual-phase ^99Tc^m-MIBI scintigraphy in the localization and diagnosis of secondary hyperparathyroidism

目的探讨^99Tc^m-MIBI双时相显像在定位诊断继发性甲状旁腺功能亢进症（SHPT）中的临床价值。方法回顾性分析2010年至2013年间20例（男8例，女12例，平均年龄49．6岁）行甲状旁腺切除术的肾性SHPT患者影像学资料，以术后病理结果为“金标准”，计算^99Tc^m-MIBI双时相SPECT／CT显像结果与彩色多普勒超声（CDUS）对SHPT的诊断效能，同时对延迟显像中甲状旁腺摄取的最高放射性比值（T／NT）与患者近期全段PTH（iPTH）水平及术中切除的相应甲状旁腺体积的关系作分析。采用x^2检验、Pearson相关或Spearson相关分析数据。结果^99Tc^m-MIBI双时相显像和CDUS诊断SHPT的灵敏度、特异性、阳性预测值、阴性预测值、准确性分别为66．67％（44／66）、100％（14／14）、100％（44／44）、38．89％（14／36）、72．50％（58／80）和78．19％（43／55）、52．38％（11／21）、81．13％（43／53）、47．83％（11／23）、71．05％（54／76）。二者诊断SHPT的特异性和阳性预测值差异有统计学意义（x^2=9．33和9．26，均P〈0．05），其余3个指标差异均无统计学意义（x^2=1．97、0．04和0．46，均P〉0．05）。最高T／NT与患者iPTH水平及手术切除的相应甲状旁腺体积均呈正相关（r=0．638,rs=0．571，均P〈0．05）。结论^99Tc^m-MIBISPECT／CT显像诊断SHPT的特异性高于CDUS0^99Tc^m-MIBI双时相显像可准确定位功能亢进的甲状旁腺，为手术治疗提供依据。

Objective To explore the c-linical value of dual-phase ^99Tc^m-MIBI scintigraphy in the localization and diagnosis of secondary hyperparathyroidism （SHPT）. Methods A total of 20 patients （ 8 males, 12 females; average age 49.6 years） with uremic SHPT who underwent parathyroidectomy from 2010 to 2013 were retrospectively analyzed. All patients underwent ^99Tc^m-MIB1 SPECT/CT and 19 underwent color Doppler ultrasonography （CDUS）. Post-excisional histopathology was considered as the gold standard. The diagnostic efficacies of ^99Tc^m-MIBI and CDUS for SHPT were calculated. The correlation between T/NT ratio in delayed imaging and the volume of excised parathyroid and the intact PTH （iPTH） were analyzed. x^2 test, Pearson or Spearson correlation analysis were used to analyze the data. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 99Tcm-MIBI SPECT/CT and CDUS in the diagnosis of SHPT were 66.67% （44/66）, 100% （ 14/14）, 100% （44/44）, 38.89% （ 14/ 36）, 72.50% （58/80） and 78.19% （43/55）, 52.38% （ 11/21 ）, 81.13% （43/53）, 47. 83 （ 11/23 ）, 71.05% （54/76）, respectively. There were significant differences in specificity and positive predictive value （x^2= 9.33, 9.26, both P〈0.05）, but no significant differences in the sensitivity, negative predictive value and accuracy （x^2= 1.97, 0.04, 0.46, all P〉0.05）. T/NT ratio correlated with serum iPTH and parathyroid volume （r=0.638, re =0.571, both P〈0.05）. Condusions The specificity of ^99Tc^m-MIBI SPECT/CT is superior to CDUS in the diagnosis of SHPT. Dual-phase ^99Tc^m-MIBI SPECT/CT could locate the hyperfunetional parathyroid gland and provide the basis for surgical treatment.