99 Tcm-MIBI 断层及 CT 融合显像在甲状旁腺功能亢进症术前定位诊断中的价值

Value of 99 Tcm-MIBI tomography and integrated CT scan in preoperative localization diagnosis of prima-ry hyperparathyroidism

目的：探讨99锝m-甲氧基异丁基异腈（technetium-99m methoxy isobutyl isonitrile，99Tcm-MIBI）断层及同机CT融合显像在原发性甲状旁腺功能亢进症（ primary hyperparathyroidism ，PHPT）术前定位诊断中的价值。方法31例PHPT，静脉注射99 Tcm-MIBI 370 MBq后15 min行颈胸部平面显像，90 min行延迟平面显像，然后开始核素断层与CT融合显像。31例同期均行超声检查。所有显像结果与手术病理结果进行比较。结果99 Tcm-MIBI双时相平面显像、99 Tcm-MIBI 核素断层及同机CT 融合显像对PHPT的检出率分别为87.1％和93.5％，2者差异无统计学意义（P＞0.05），但均高于超声对PHPT的检出率64.5％，差异均有统计学意义（χ2分别为4.039和7.884，P均＜0.05）。99 Tcm-MIBI核素断层及同机CT融合显像对甲状旁腺增生的检出率均为80.0％，高于超声和99 Tcm-MIBI双时相平面显像的40.0％。同机CT融合显像可提供详细的解剖定位，为手术医师提供更多的信息。结论99 Tcm-MIBI断层及同机CT融合显像较单纯的双时相平面显像对PHPT病灶的检出率有所提高，可提供更多的解剖信息，在PHPT的术前定位诊断中有较高的临床价值。

Objective To evaluate the value of technetium-99m methoxy isobutyl isonitrile（99Tcm-MIBI） tomography and integrated CT scan in preoperative localization diagnosis of primary hyperparathyroidism （PHPT）. Methods 31 patients with PHPT were selected .15 minutes and 90 minutes （ delayed images ） after intravenous administration of 99 Tcm-MIBI 370 MBq, static anterior planar images of the neck and chest were obtained .99 Tcm-MIBI tomography and integrated CT scan were acquired after the delayed images .All patients received neck ultra-sound scan before surgery .The imaging findings were compared to the pathological results .Results The detec-tion rate of hyperparathyroidism lesions of 99 Tcm-MIBI dual-phase imaging and 99 Tcm-MIBI tomography and regis-tration with integrated CT scan was 87.1%and 93.5%respectively, without statistical significance （P〉0.05）. However , they were both higher than ultrasound scan which had a detection rate of 64.5%.The differences had statistical significance （χ2 =4.039 and 7.884 respectively , P〈0.05 ） .The detection rate of parathyroid hyper-plasia of 99 Tcm-MIBI tomography and registration with integrated CT was both 80.0%, higher than that of the ul-trasound test（40.0%）and 99Tcm-MIBI dual-phase imaging（40.0%）.The fusion imaging with integrated CT scan provided detailed anatomy data and more information for surgical doctors .Conclusions 99 Tcm-MIBI tomography and registration with integrated CT scan can improve the detection rate of PHPT compared with 99 Tcm-MIBI dual-phase imaging , provide detailed anatomy data , and has high clinical value in preoperative localization diagnosis of PHPT.