不同影像学检查方法对原发性甲状旁腺功能亢进症患者甲状旁腺病灶的定位诊断价值

Different imaging methods in localization diagnosis of parathyroid gland lesions in primary hyperparathyroidism

目的探讨不同影像学检查方法对原发性甲状旁腺功能亢进症(PHPT)的诊断价值。方法回顾性分析经病理学检查证实的109例PHPT患者的临床资料,将其超声、MRI、CT、^(99) Tc^m-MIBI检查定位诊断结果与手术后病理学结果比较分析。结果 109例PHPT中,甲状旁腺癌11例(11/109,10.09%),增生16例(16/109,14.67%),甲状旁腺瘤82例(82/109,75.23%),包括单发病灶74例(74/109,67.89%),双侧腺瘤8例(8/109,7.34%)。腺瘤、增生、腺癌组病灶发生部位的差异有统计学意义(χ~2=36.151,P<0.001)。^(99)Tc^m-MIBI、MRI、CT、超声术前检查定位的准确率分别为83.50%(81/97)、72.22%(13/18)、68.51%(37/54)、67.67%(67/99),差异无统计学意义(χ~2=4.826,P=0.185);超声明显低于^(99)Tc^m-MIBI检查(χ~2=6.638,P=0.001),CT明显低于^(99)Tc^m-MIBI检查(χ~2=4.562,P=0.033),CT与MRI的定位诊断准确率差异无统计学意义(χ~2=1.153,P=0.283)。对于术后病理诊断直径<1cm的病变,^(99)Tc^m-MIBI、超声、CT、MRI术前检查定位的准确率分别为77.27%(17/22)、35.00%(7/20)、61.53%(8/13)、66.67%(2/3),差异有统计学意义(χ~2=7.881,P=0.049),^(99)Tc^m-MIBI的定位准确率高于超声(χ~2=7.664,P=0.006),但与CT、MRI的差异无统计学意义(χ~2=2.154,P=0.175)。结论对PHPT进行定位诊断时,超声仍是首选检查,^(99)Tc^m-MIBI双时相显像的诊断价值最高。

Objective To explore the diagnostic value of different imaging methods in the diagnosis of primary hyperthy- roidism （PHPT）. Methods Clinical data of 109 patients with PHPT confirmed by pathological examination were retrospectively analyzed. The imaging location diagnosis of the ultrasound, MRI, CT, 99 Tcm_MIBI and the pathologic results after surgery were compared. Results In 109 PHPT patients, there were 82 （82/109, 75.23%） cases of parathyroid adeno- ma, and single parathyroid adenoma accounting for 67.890/~ （74/109）, bilateral parathyroid adenoma accounting for 7.34 % （8/109）. There were 16 （16/109, 14.67%） cases of parathyroid hyperplasia, and 11 （11/109, 10. 09%） cases of parathy- roid carcinoma. There were significant differences among parathyroid adenoma, parathyroid hyperplasia and parathyroid carcinoma group in lesion sites （x2=36. 151, P（0. 001）. The accuracy of 99Tem-MIBI, MRI, CT and ultrasonography were 83.50% （81/97）, 72.22% （13/18）, 68. 51% （37/54）, 67.67% （67/99）. There were no differences among 99Tcm- MIBI, MRI, CT and ultrasonography （Z2 = 4. 826, P= 0. 185）. The accuracy of ultrasonography and CT was abviously lower than that of 99Tcm-MIBI （X2=6. 638, P〈0. 001 and Z2 =4. 562, P=0. 033）, There were no differences for MRI compared to CT （X2= 1. 153, P= 0. 283）. The accuracy preoperative localization of 99 Tcm_MIBI, ultrasonography, CT, MRI were 77.27% （17/22）, 35.00% （7/20）, 61.53% （8/13）, 66.67% （2/3） in lesions with diameter of less than 1 cm （x2 =7. 881, P=0. 049）. The accuracy of 99 Tcm MIBI was obviously higher than that of ultrasonography （X2 = 7. 664, P〈 0. 006） and there were no differences between CT and MRI （x2=2. 154, P〈0. 175）. Conclusion In localization diagnosis of parathyroid gland lesions in patients with PHPT, ultrasonography is still the preferred examination method, and 99 Tcm_ MIBI has highest value.