^(99m)Tc-MIBI SPECT/CT甲状旁腺显像发现颈部恶性肿瘤的价值及与超声对比

The value of ^(99m)Tc-MIBI SPECT/CT parathyroid imaging and ultrasound in incidental detection of neck carcinoma

目的:评价^(99m)Tc-甲氧基异丁基异腈(^(99m)Tc-methoxyisobutyl isonitrile, ^(99m)Tc-MIBI)单光子发射计算机断层扫描(single-photon emission computed tomography,SPECT)/CT甲状旁腺显像检查在意外发现颈部恶性肿瘤中的价值,并与超声检查进行对比。方法:回顾性分析952例临床疑似原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT),同时行颈部SPECT/CT和超声检查的患者,以手术及病理检查结果作为诊断金标准,对比影像学检查结果进行分析,计算SPECT/CT及超声检查对疑似PHPT患者伴发的颈部恶性肿瘤,特别是甲状腺癌的发病情况,以及定位诊断的灵敏度、特异度、准确率。结果:952例患者中有304例患者行手术治疗,并得到352个术后病理学结果,其中颈部恶性肿瘤共64例(83个病灶),包括22例(34.38%)甲状旁腺癌,24例(37.50%)甲状腺乳头状癌,4例(6.25%)甲状腺滤泡状癌,7例(10.94%)甲状腺髓样癌,7例(10.94%)其他肿瘤。SPECT/CT和超声检查诊断颈部恶性肿瘤的灵敏度分别为51.56%和76.56%,特异度分别为91.32%和95.14%,诊断准确率分别为84.10%和91.76%。其中,SPECT/CT和超声检查诊断甲状腺癌的灵敏度分别为54.29%和85.71%,特异度分别为91.18%和94.01%,准确率分别为87.50%和93.18%。结论:PHPT伴发颈部恶性肿瘤并不少见。尽管^(99m)Tc-MIBI SPECT/CT显像在诊断和定位PHPT病变时非常重要,可以发现并定位颈部恶性肿瘤,但超声检查对伴发PHPT病变的颈部恶性肿瘤及甲状腺癌的诊断灵敏度更高。

Objective: To investigate the value of99mTc-MIBI SPECT/CT parathyroid imaging and ultrasound in incidental detection of neck carcinoma. Methods: A total of 952 patients with clinically suspected primary hyperparathyroidism(PHPT) undertaken ultrasonography and99mTc-MIBI SPECT/CT of base of skull, neck and thorax were enrolled.Each case with suspected lesion was analyzed and correlated with pathological finding. The frequency of carcinoma on SPECT/CT performed for PHPT was calculated. Sensitivity, specificity and accuracy for head and neck carcinoma, espe-cially thyroid carcinoma of both the SPECT/CT and ultrasound were calculated. Results: Among the 952 patients, a total of 304 patients were treated with surgery and 352 pathological results were obtained. And finally, 64 carcinoma(83 sites)were found. The anatomical distribution was as follows: 22(34.38%) were parathyroid carcinoma, 24(37.50%) were papil-lary thyroid carcinoma, 4(6.25%) were follicular thyroid carcinoma, 7(10.94%) were medullary thyroid carcinoma and 7(10.94%) were other tumors. The sensitivity of SPECT/CT and ultrasound for neck carcinoma were 46.99% and 74.70%,respectively. Specificity was 91.21% for SPECT/CT and 94.79% for ultrasound. Accuracy was 81.79% for SPECT/CT and90.51% for ultrasound. The sensitivity of SPECT/CT and ultrasound for thyroid carcinoma were 39.31% and 80.43%, respectively. Specificity was 90.12% for SPECT/CT and 92.73% for ultrasound. Accuracy was 84.10% for SPECT/CT and91.28% for ultrasound. Conclusions: The concomitant occurrence of PHPT and neck carcinoma is not uncommon. Although99mTc-MIBI SPECT/CT plays an important role for the diagnosis and location of PHPT lesions, ultrasound is a better choice for detecting neck carcinoma, such as thyroid carcinoma accompanied the PHPT.