99Tcm-MIBI SPECT/CT融合显像在甲状旁腺功能亢进症术前诊断中的应用价值

Value of 99Tcm-MIBI SPECT/CT in pre-operative diagnosis of primary and secondary hyperparathyroidism

目的 通过与平面显像及超声检查比较,评估99Tcm-MIBI SPECT/CT融合显像在HPT患者术前诊断中的价值.方法 回顾性分析2016年3月至2016年10月57例在四川大学华西医院核医学科行99Tcm-MIBI SPECT/CT显像、平面显像及颈部超声检查的HPT患者,其中男9例、女48例,年龄（529±15.5）岁.以手术病理结果为＂金标准＂,用χ2检验比较不同检查方法的诊断效能.结果 57例HPT患者经术后病理证实共有86处病灶, 其中PHPT病灶47处, SHPT病灶39处.SPECT/CT、平面显像、超声及联合显像（平面显像＋超声）对HPT病灶的诊断灵敏度分别为87.21%（75/86）、69.77%（60/86）、65.12%（56/86）、84.88%（73/86）,SPECT/CT的诊断灵敏度明显高于平面显像及超声（χ2值：4.691和7.818,均P〈0.05）,但与联合显像差异无统计学意义（χ2=0.044,P〉0.05）.SPECT/CT、平面显像、联合显像及超声对PHPT病灶的诊断灵敏度分别为95.74%（45/47）、93.62%（44/47）、9787%（46/47）、76.60%（36/47）,前三者差异无统计学意义（χ2=1.044,P〉0.05）,但均高于超声（χ2=16.223,P〈0.05）.SPECT/CT、平面显像、超声及联合显像对SHPT病灶的诊断灵敏度分别为76.92%（30/39）、41.03%（16/39）、51.28%（20/39）、69.23%（27/39）,SPECT/CT灵敏度高于平面显像及超声（χ2值：10.386和5.571,均P〈0.05）,但与联合显像的差异无统计学意义（χ2=0.586,P〉0.05）.4种显像方法对HPT病灶诊断的特异性差异无统计学意义（χ2=2.219,P〉0.05）.只有SPECT/CT能够精确定位所有异位病灶.结论 99Tcm-MIBI SPECT/CT融合显像对SHPT病灶定位灵敏度高于平面显像及超声;对异位病灶及拟行微创手术的HPT患者,SPECT/CT可提供更精确的病灶定位信息.

Objective To evaluate the value of pre-operative 99Tcm-MIBI SPECT/CT in patients with HPT by comparing with planar 99Tcm-MIBI and ultrasound imaging. Methods A total of 57 patients （9 males, 48 females; average age： （52.9±15.5） years） were enrolled into this retrospective study. They all underwent 99Tcm-MIBI planar scintigraphy, 99Tcm-MIBI SPECT/CT and ultrasound during March to October in 2016. All patients received parathyroidectomy and the surgical pathology was considered as the gold standard. The diagnostic efficiencies were compared using χ2 test. Results A total of 86 HPT lesions were confirmed, including 47 lesions in 46 PHPT patients and 39 lesions in 11 SHPT patients. The sensitivities of SPECT/CT, planar, ultrasound and combined imaging （planar plus ultrasound） were 87.21%（75/86）, 69.77%（60/86）, 65.12%（56/86） and 84.88%（73/86）, respectively. The overall sensitivity of SPECT/CT was significantly higher than that of individual planar imaging and that of ultrasound （χ2 values： 4.691 and 7.818, both P〈0.05）, but similar to that of the combined imaging （χ2=0.044, P〉0.05）. No significant difference was observed among the specificities of all these modalities （χ2=2.219, P〉0.05）. For PHPT lesions, the sensitivities of SPECT/CT, planar imaging, combined imaging and ultrasound were 9574%（45/47）, 93.62%（44/47）, 97.87%（46/47） and 76.60%（36/47）, respectively. No statistically significant difference was found in the sensitivity of the former 3 modalities （χ2=1.044, P〉0.05）, but the sensitivity of ultrasound was the lowest（χ2=16.223, P〈0.05）. For SHPT, the sensitivities of the corresponding 4 modalities were 76.92%（30/39）, 41.03%（16/39）, 51.28%（20/39） and 69.23%（27/39）, respectively. SPECT/CT was significantly superior to planar imaging and ultrasound（χ2 values： 10.386 and 5.571, both P〈0.05）, but comparable to the combined imaging（χ2=0.586, P〉0.05）. Only SPECT/CT could accurately localize 5 ectopic HPT lesions. Conclusion Compared to planar imaging and ultrasound, SPECT/CT has higher sensitivity for SHPT patients, and could provide precise localization for ectopic lesions, thus facilitating patient planning for minimally invasive surgery.