甲状旁腺增生的MSCT表现

MSCT Findings of Parathyroid Hyperplasia

目的探讨甲状旁腺增生(PH)的多层螺旋CT(MSCT)表现,提高诊断正确率,减少漏诊。方法回顾性分析47例经手术及病理证实的PH患者的MSCT资料,并纳入实验组,对PH的发生部位、形态学特征、强化特点及周围毗邻关系进行分析,同期8例甲状旁腺腺瘤(PA)患者设为对照组,比较两组MSCT表现的异同。结果 47例PH患者中,CT检出病灶158个,与手术结果(n=175)的符合率为90.3%。CT测量PH病灶的面积在0.21~6.72 cm^2之间。原发性甲状旁腺功能亢进(PHPT)与继发性甲状旁腺功能亢进(SHPT)患者在PH病灶的面积(t=-0.918,P=0.360>0.05)上进行比较,差异无统计学意义,但二者在血清磷的浓度(t=4.693,P=0.000<0.05)上进行比较,差异有统计学意义。47例PH单侧或双侧均可发生,双侧发生多见,且形态不对称。病灶形态呈类圆形或椭圆形,平扫呈软组织密度,无出血、囊变或坏死。PHPT患者的PH无钙化;SHPT患者的PH钙化发生率为60.5%;PH造成骨骼改变表现为多发囊性改变和/或毛玻璃片样改变。PH的动态增强扫描时间-密度曲线为缓慢上升型和速升缓降型。病理上PH与PA在病灶最大径(t=-3.792,P=0.000<0.05)上进行比较,差异有统计学意义,其他鉴别在平扫及增强图像上差异不大。结论 PH发生特定的解剖区域,单发或双侧不对称发生,SHPT患者的PH的钙化率及骨骼改变发生率较高,CT增强扫描有助于PH的识别。

Objective To explore the MSCT（Multislice Helical CT） findings of PH（Parathyroid Hyperplasia）,and to improve the accuracy of diagnosis. Methods Retrospective studies of non-enhanced CT（NECT） or/and CECT（contrast enhanced CT） scannings have been applied in 47 cases with PH（experimental group） and in 8 cases（control group） with PA（Parathyroid Adenoma）,which have been demonstrated by Surgery and pathology. The similarities and differences of MSCT between the two groups were compared,including four elements such as location,morphological characteristics,enhanced characteristics and relationship of adjacent regions. Results Among the 47 cases of PH,158 lesions were found by CT examination; the coincidence rate with surgical results（n = 175） was 90. 3%. PH size between 0. 21cm^2 to 6. 72 cm^2 were selected. Statistically significant difference（t = 4. 693,P = 0. 000〈 0. 05） was found between two groups in the serum concentrations of phosphorus in patients with PE of PHPT（Primary hyperparathyroidism,PHPT） and SHPT（Secondary hyperparathyroidism）,but no statistically significant difference（t =-0. 918,P = 0. 360〉 0. 05） showed in the area of PE. In47 cases of PH,unilateral/bilateral lesions were of soft tissue density on the NECT images with a round or oval shape,and without hemorrhage,cystic change or necrosis. The incidence of calcification in PE patients with SHPT was 60. 5%. on the contrary,there was no calcification in PHPT. Bone changes of PH are manifested as multiple cystic changes and/or groundglass change. The time-density curve of dynamic-enhanced scanning of PH showed the slow rise type or the rapid rise then slow drop type. Both PH and PA groups revealed a statistically significant difference（t =-3. 792,P = 0. 000〈 0. 05）with comparison of maximum diameter of the lesion in Pathology,but no statistically significant difference with other manifestations neither on NECT or CECT images. Conclusion PH occurs in specific anatomical locations,unilaterally or bilaterally as well as asymmetrically. The incidence of calcification and bone changes in PE patients with SHPT was higher than that in patients with PHPT. CECT scanning is helpful in the identification of PH.