^(99m)Tc-MIBI SPECT/CT融合显像对原发性甲状旁腺功能亢进症病灶定位诊断的增益价值

^(99m)Tc-MIBI SPETC/CT fusion imaging on localization diagnosis of primary hyperparathyroidism

目的探讨99m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)对原发性甲状旁腺功能亢进症(PHPT)病灶定位诊断的增益价值。方法原发性甲状旁腺功能亢进症(PHPT)患者71例,静注99mTc-MIBI 740 MBq,于注射后15分钟和2~3小时分别采集颈胸部早期和延迟平面显像,延迟平面显像后行颈胸部SPECT/CT同机融合显像。两位阅片者独立分析99mTc-MIBI双时相平面显像与SPECT/CT融合显像,每一个诊断结果分配一个解剖位置,并分为5个等级。对两位阅片者的分析结果进行一致性分析;根据手术和病理结果,分别比较两种显像方法诊断PHPT病灶的敏感度、特异度、阳性预测值、阴性预测值和ROC曲线下面积。分析影响99mTc-MIBI甲状旁腺显像敏感度的因素。结果 SPECT/CT融合图像比平面图像的分析一致性明显提高。手术的55例甲状旁腺病变患者共病理确诊59个病灶,SPECT/CT融合显像对PHPT病灶诊断的敏感度为98.3%,明显高于双时相平面显像88.1%的敏感度(P<0.05)。MGD是影响甲状旁腺显像敏感度的因素。SPECT/CT融合显像可提供病灶的解剖位置,尤其方便异位PHPT病灶的定位或术中探查。结论99mTc-MIBI SPECT/CT是探查PHPT病灶的有效诊断方法,综合临床价值高于双时相平面显像。

Objective To investigate incremental value of 99m Tc-sestamibi （99mTc-MIBI） single photon emission computed tomography/computed tomography （SPECT/CT） in the diagnostic localization of parathyroid lesions in patients with pri- mary hyperparathyroidism （PHPT）. Methods 71 patients with PHPT were selected. 30 min （ early phase） and 2 - 3 h （delayed phase ） after intravenous administration of 99mTc-MIBI （740 MBq）, dual-phase planar imaging over the neck and chest was performed followed by SPECT/CT imaging. The 99mTc-MIBI dual-phase planar imaging and the SPECT/CT fusion imaging were interpreted separately. Each positive finding was assigned an anatomic location and graded on a 5-point scale. A- greement of the tow readers was quantified. The imaging findings were compared to the pathological results. Sensitivity, speci- ficity, positive predictive value, negative predictive value, and area under the curve were determined for each method. The influence factors on the sensitivity of the parathyroid scintigraphy is analyzed. Results The agreement of SPECT/CT fusion im- age is much better than dual-phase planar imaging. In total,59 lesions from 55 patients with PHPT were confirmed by patho- logical. The sensitivity of SPECT/CT （98.3 % ） was significantly greater than that of double-phase planar imaging （88.1% ） （P 〈 0. 05 ）. The sensitivity of 99mTc-MIBI parathyroid scintigraphy is affected by MGD. SPECT/CT also provided exact ana- tomical locations of the lesions,which was especially helpful for the surgical treatment of ectopic PHPT lesions.. Conclusion 99m Tc-MIBI SPECT/CT is more effective than conventional 99mTc-MIBI dual-phase planar imaging in diagnosis of PHPT.