^(99m)Tc-MIBI SPECT/CT显像诊断原发性甲状旁腺功能亢进症的价值

Value of ^(99m)Tc-MIBI single photon emission computed tomography/computerized tomography in the diagnosis of primary hyperparathyroidism

目的·评价^(99m)锝-甲氧基异丁基异腈(^(99m)Tc-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)的诊断价值和优势。方法·系统回顾为诊断PHPT而行^(99m)Tc-MIBI SPECT/CT显像的249例患者的临床资料,以术后病理诊断及临床随访为最终结果,与同期颈部超声、血液指标检查(根据WHO制订的诊断标准需同时满足高甲状旁腺激素、高血钙)及双时相平面显像(静脉注射^(99m)Tc-MIBI 740 MBq后行颈胸部30 min及120 min的早期和延迟双时相静态平面采集)结果对比。结果·249例患者中,^(99m)Tc-MIBI SPECT/CT显像诊断PHPT的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为89.9%、88.1%、90.4%、85.0%、88.0%;颈部超声分别为82.7%、57.8%、74.3%、69.3%、72.6%;血液指标分别为91.4%、82.6%、87.1%、80.4%、87.6%;平面显像分别为77.9%、89.0%、90.1%、75.8%、82.7%。结论·^(99m)Tc-MIBI SPECT/CT显像诊断PHPT有较大的价值,综合临床价值高于颈部超声及^(99m)Tc-MIBI双时相平面,且能准确定位病灶位置,对手术具有很好的指导意义。

Objective·To evaluate diagnostic value and advantages of ^99mTc-MIBI single photon emission computed tomography integrated with X-ray computerized tomography （SPECT/CT） in diagnosing patients with primary hyperparathyroidism （PHPT）. Methods·Clinical data, postoperative pathological diagnosis, and clinical follow-up results of 249 patients with PHPT who underwent ^99mTc MIBI SPECT/CT for diagnosis were systematically reviewed and compared with neck ultrasound, blood index tests （according to the diagnostic criteria of WHOs that must meet both high PTH and hypercalcemia）, and double phase planar imaging （intravenous injection of ^99mTc MIBI 740 MBq and undergoing 30 min and 120 min of cervical and thoracic early and delayed double phase static plane acquisition） results. Results·For 249 patients, diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ^99mTc-MIBI SPECT/CT for the diagnosis of PHPT were 89.9%, 88.1%, 90.4%, 85.0%, and 88.0%. Those of neck ultrasound were 82.7%, 57.8%, 74.3%, 69.3%, and 72.6%.Those of blood indexes were 91.4%, 82.6%, 87.1%, 80.4%, and 87.6%. Those of planar imaging were 77.9%, 89.0%, 90.1%, 75.8%, and 82.7%. Conclusion·^99mTc-MIBI SPECT/CT has greater clinical diagnostic value of PHPT than neck ultrasound and ^99mTc-MIBI double phase planar imaging and can accurately locate lesions, so as to facilitate the parathyroidectomy.