^(99m)Tc-MIBI SPECT-CT显像在纵隔内异位甲状旁腺诊治中的应用价值

Application value of ^(99m)Tc-MIBI SPECT-CT scintigraphy in diagnosis and treatment of mediastinal ectopic parathyroid

目的分析99mTc-甲氧基异丁基异腈(MIBI)单光子发射计算机断层显像(SPECT)-CT显像在纵隔内异位甲状旁腺诊治中的应用价值。方法以2013年8月至2014年2月北京世纪坛医院收治的100例继发性甲状旁腺功能亢进症(SHPT)患者为研究对象,所有患者均采用99mTc-MIBI双时相法显像、平面和断层显像及同机CT成像,分析纵隔内异常放射性浓聚灶融合图像,以及肿瘤与对侧正常组织(T/NT)放射性比值同全段甲状旁腺激素(iPTH)、手术病理结果的关系。结果 100例患者中出现纵隔内异位甲状旁腺2例(2.0%),其中1例于显像前给予甲状旁腺切除术,术后全段甲状旁腺激素(iPTH)再次升高;另1例给予药物治疗,2例患者术后SPECT-CT显像均显示异位甲状旁腺显像,定位于胸锁关节。平面和断层显像及同机CT成像显示,甲状旁腺的最高T/NT放射性比值与显像前iPTH水平呈正相关(r=0.419,P<0.05);T/NT放射性比值的升高幅度与其对应手术切除的甲状旁腺体积呈正相关(r=0.376,P<0.05)。采用CT及SPECT-CT显像时,异位甲状旁腺的敏感性优于常位甲状旁腺,而两者的阳性数、自由门静脉压(FPP)、假阳性数比较差异无统计学意义(P>0.05)。结论99mTc-MIBI SPECT-CT显像能够有效地融合解剖图像和功能图像,对SHPT的诊断具备较高的特异性、灵敏性及准确性,同时可对病灶进行准确定位,提高手术效率,使手术达到令人满意的效果。

Objective To analyze the application value of single photon emission computed tomography（SPECT）-CT99mTc-methoxyisobutylisonitrile（MIBI）scintigraphy in the diagnosis and treatment of mediastinal ectopic parathyroid.Methods 100 cases of secondary hyperparathyroidism in the Beijing Shijitan Hospital from Aug.2013 to Feb.2013 were selected as the research subjects and performed the 99mTc-MIBI dual-phase scintigraphy,plane and SPECT and CT imaging with the same machine.The fused images of mediastinal abnormal radioactive high uptake lesions were analyzed.And the relationship between T/NT radioactivity ratio and intact parathyroid hormone（iPTH）level and pathological results were also analyzed.Results Among 100 cases,mediastinal ectopic parathyroid appeared in 2cases（2.0%）,in which 1case was given the parathyroidectomy before imaging and the postoperative iPTH was increased again;another case was treated by medication.These two cases showed the ectopic parathyroid imaging by postoperative SPECT-CT imaging,which located in the sternoclavicular joint.The plane,SPECT and CT imaging with the same machine showed that the highest T/NT radioactivity ratio of parathyroid was positively correlated with the iPTH level before imagine（r=0.419,P〈0.05）;the ascending range of T/NT radioactivity ratio was positively correlated with the parathyroid volume resected by corresponding operation（r=0.376,P〈0.05）.By adopting CT and SPECT-CT imaging,the sensitivity of ectopic parathyroid was superior to the orthotopic parathyroid,whereas the positive number,free portal vein pressure（FPP）and false positive number had no statistical differences between them（P〉0.05）.Conclusion ^99mTc-MIBI SPECT-CT scintigraphy could effectively fuse the anatomical images and functional images,may have the extremely high specificity,sensitivity and accuracy for the diagnosis of hyperparathyroidism,at the same time could accurately localize the lesions,increase the operation efficiency and make the operation to reach the satisfactory effect.