核素显像对尿毒症患者甲状旁腺功能亢进症的术前定位价值

Value of radionuclide imaging in diagnosis of secondary hyperparathyroidism in uremic patients

目的评价放射性核素药物^99Tc^m-MIBI显像对继发性于尿毒症的甲状旁腺功能亢进症的术前定位诊断价值。方法回顾分析32例因尿毒症所致的甲状旁腺功能亢进症和肾性骨病患者的术前^99Tc^m-MIBI双时相显像资料，并对比患者术前超声和手术切除异常甲状旁腺组织的病理资料。所有32例患者术后病理均有甲状旁腺异常病变，其中甲状旁腺增生12例，甲状旁腺增生伴腺瘤14例，甲状旁腺腺瘤6例；在手术切除的79枚病灶中，77枚为甲状旁腺病变，2枚为甲状腺病变。结果32例患者术前^99Tc^m-MIBI显像均有甲状旁腺异常浓聚灶，即阳性病灶，共82枚；其中1枚病灶患者2例，2枚病灶16例，3枚病灶8例，4枚病灶6例，2枚以上病灶患者占93．7％；^99Tc^m-MIBI显像的82枚阳性病灶中，77枚手术证实为甲状旁腺病灶，另2枚手术为甲状腺腺瘤，3枚阳性病灶未行切除。术前32例患者的B超则显示：阳性病例26例，发现病灶65枚，其与手术所见一致59枚。与术后病理结果对比：^99Tc^m-MIBI显像对继发于尿毒症的甲状旁腺功能亢进症的病例定性诊断符合率100％（32／32），对可手术切除的甲状旁腺病灶的检出率为100％（77／77），对病灶的阳性预测值为93．9％（77／82）；而B超的病例定性诊断符合率为81．3％（26／32），对可手术切除的甲状旁腺病灶检出率为76．6％（59／77），对病灶的阳性预测值为90．7％（59／65）。结论^99Tc^m-MIBI显像对继发性于尿毒症的甲状旁腺功能亢进症患者的术前定位诊断有极高价值，明显高于B超检查，应作为术前的常规病灶定位检查。

Objective To evaluate the preoperative localization value of ^99Tc^m-MIBI double-phase imaging in uremic patients with secondary hyperparathyroidism. Methods The preoperative ^99Tc^m-MIBI double-phase imaging of 32 patients with hyperparathyroidism secondary to uremia was retrospective analyzed, comparing with their serum IPTH, neck ultrasonography, and pathological result. Results 82 loci of hyperparathyroidism were detected by ^99Tc^m-MIBI imaging, of those 2 cases with 1 focus, 16 with 2 foci, 8 with 3 loci, and 6 with 4 loci. All of 32 cases with 79 loci were confirmed as hyperparathyroidism with pathological results. Of those 12 were with hyperplasia, 14 with hyperplasia and adenoma, and 6 with adenoma. 77 positive foci by ^99Tc^m-MIBI imaging were concordant with the pathological results. Of 32 subjects the preoperative ultrasonography identified 26 as positive with 65 foei, among them 59 were concordant with the pathological results. Coincidence rate of ^99Tc^m-MIBI imaging in the diagnosis and localization for excised lesions and positive value for lesions of hyperparathyroidism secondary to uremia were 100%, 100% and 93.9% respectively. As for ultrasonography the diagnostic accordiance rates,operable focus detection rate,and positive predictive value were 81.3% , 76.6% and 90.7% , respectively. Conclusion ^99Tc^m-MIBI imaging is valuable in localizing hyperparathyroidism secondary to uremia and should be taken as routine before operation.