^(99)Tc^m-MIBISPECT-MIBISPECT双时相显像、B超及CT在原发性甲状旁腺功能亢进症中的诊断价值

^(99)Tc^m-MIBI SPECT Dual-Phase Imaging,B-Ultrasound,and CT in The Diagnostic Value of Primary Hyperparathyroidism

目的探讨^(99)Tc^m-甲氧基异丁基异腈单光子发射计算机断层显像(^(99)Tc^m-MIBI SPECT)双时相显像、B超及CT检查诊断原发性甲状旁腺功能亢进症(PHPT)的意义及与血清钙(CA)水平的关系。方法回顾性分析73例血清甲状旁腺激素(PTH)均大于130 pg/m L甲状旁腺功能异常患者的临床资料,73例患者均行^(99)Tc^m-MIBI SPECT双时相显像检查,63例行颈部B超检查,16例行CT检查;根据血清钙(CA)水平将患者分为CA<2.7 mmol/L组和CA>2.7mmol/L组,并以术后病理学检查及随访结果为标准,比较不同血清CA水平下^(99)Tc^mMIBI SPECT双时相显像、B超及CT检查诊断PHPT的灵敏度、特异度、阳性预测值及阴性预测值。结果 ^(99)Tc^mMIBI SPECT双时相显像、B超和CT检查诊断PHPT的灵敏度分别为87.6%、81.8%及35.7%,特异度分别为87.5%、75.5%及50.0%,阳性预测值分别为98.2%、93.7%及83.3%,阴性预测值分别46.7%、33.3%和10.0%。^(99)Tc^mMIBI SPECT双时相显像和B超检查诊断PHPT的灵敏度、特异度、阳性预测值及阴性预测值均明显高于CT检查(P<0.05);^(99)Tc^m-MIBI SPECT双时相显像诊断PHPT的灵敏度、特异度、阳性预测值及阴性预测值高于B超检查,但差异无统计学意义(P>0.05)。在CA<2.7 mmol/L组,^(99)Tc^m-MIBI SPECT双时相显像、B超及CT检查诊断PHPT的灵敏度分别为91.1%、84.7%和37.9%,特异度分别为80.2%、72.9%及49.7%,阳性预测值分别为96.8%、96.0%和79.4%,阴性预测值分别为50.0%、37.5%及10.0%;在CA>2.7mmol/L组,^(99)Tc^m-MIBI SPECT双时相显像、B超及CT检查诊断PHPT的灵敏度分别为87.9%、83.9%及42.8%,特异度分别为83.3%、79.2%及50.0%,阳性预测值分别为96.9%、94.1%及75.0%,阴性预测值分别为50.0%、40.5%及20.0%,2组间3种检查方法的诊断准确性的差异均无统计学意义(P>0.05)。结论 ^(99)Tc^m-MIBI SPECT双时相显像和B超在PTH大于130 pg/m L的PHPT患者中(尤其甲状旁腺腺瘤)其诊断准确性明显高于CT,且与血清CA浓度无关。

Objective To investigate the significance of ^99Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT in the diagnosis of primary hyperparathyroidism, and its relationship with the level of serum calcium （CA）. Methods The clinical data of 73 patients with parathyroid dysfunction （serum parathyroid hormone （PTH）〉130 pg/ mL） were retrospectively analyzed. The ^99Tc^m-MIBI SPECT double phase imaging were performed in 73 cases, 63 cases underwent cervical B-ultrasound examination, and 16 cases underwent CT examination. According to the serum calcium （CA） levels, the patients were divided into CA〈2.7 mmol/L group and CA〉2.7 mmol/L group, and the postoperative pathological examination and followed-up results were as the standard, the sensitivity, specificity, positive predictive value, and negative predictive value of ^99Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT for diagnosis of PHPT in different serum CA levels were compared. Results The sensitivity of ^99Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.6%, 81.8% and 35.7%, respectively; the specificity was 87.5%, 75.5% and 50.0%, respectively; the positive predictive value was 98.2%, 93.7% and 83.3%, respectively; and the negative predictive value was 46.7%, 33.3% and 10%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of ^99Tc^m-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT were significantly higher than those of CT examination （P〈0.05）. The sensitivity, specificity, positive predictive value and negative predictive value of ^99Tc^m-MIBI SPECT dual-phase imaging for diagnosis of PHPT were higher than those of B-ultrasound examination, but the difference was not statistically significant （P〉0.05）. In the CA〈2.7 mmol/L group, the sensitivity of ^99Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 91.1%, 84.7% and 37.9%, respectively; the specificity was 80.2%, 72.9% and 49.7%, respectively; the positive predictive value was 96.8%, 96.0% and 79.4%, respectively; and the negative predictive value was 50.0%,37.5% and 10.0%. In the CA〉2.7 mmol/L group, The sensitivity of ^99Tc^m-MIBI SPECT dual-phase imaging, B-ultrasound and CT examination for diagnosis of PHPT was 87.9%, 83.9% and 42.8%, respectively; the specificity was 83.3%, 79.2% and 50.0%, respectively; the positive predictive value was 96.9%, 94.1% and 75.0%, respectively; and the negative predictive value was 50.0%,40.5% and 20.0%. There were no significant difference in the diagnostic accuracy between the 3 methods and the level of serum CV in different levels. Conclusions The diagnostic accuracy of ^99Tc^m-MIBI SPECT dual-phase imaging and B-ultrasound examination for diagnosis of PHPT patients with PTH〉 130 pg/mL （especially parathyroid adenoma） were higher than that of CT examination, and it is not associated with the serum CA concentration.