原发性甲状旁腺亢进中不同种影像诊断方法的比较和联合应用的价值观察

The cmparison of different imaging diagnostic methods and the combined application value for primary hyperparathyroidism

目的探讨单光子发射计算机断层成像术(SPECT/CT)、甲状旁腺双时像平面显像、CT及超声检查在原发性甲状旁腺功能亢进(PHPT)中的诊断价值。方法回顾性分析70例,男22例,女48例,临床疑似PHPT并经手术切除的患者,最终获得病理结果。所有患者均行99mTc-MIBI双时相平面显像、颈部CT平扫、SPECT/CT断层同机融合显像及超声检查。每个患者以4个甲状旁腺计算,70个患者共计280个甲状旁腺。以最终病理诊断做为诊断标准。以多个样本率间的多重比较检验各种方法的特异性及灵敏性的差异,以及诊断能力最高的两者联合应用与单一应用对诊断能力的影响。结果共计切除70个患者甲状旁腺70个,病理诊断甲状旁腺腺瘤42例,甲状旁腺双时像断层/CT融合显像灵敏度最高,超声的特异性最高。甲状旁腺双时像断层/CT融合显像与超声联合应用时,特异性、灵敏性及准确性与单独使用一种方法对比均有统计学意义。结论 SPECT/CT显像较传统平面显像有更高的诊断价值,甲状旁腺双时像断层/CT融合显像与超声联合检查,能为接下来的治疗提供更丰富的信息。

Objective To compare the value among the SPECT/CT, the planar scintigraphy in dual time, ultrasound （US） and CT. Methods The 70 patients （22 males, 48 females） who came to our department with suspicious PHPT were retrospec- tively recruited. SPECT/CT, the planar scintigraphy in dual time, US and CT were all used in each patients. There were totally 280 parathyroid glands in 70 patients. All of them were verified by pathological examination which was regarded as the diagnostic criteria. The sensitivity and specificity were compared by the test of multiple comparisons among multiple sample rates. Two ways which were considered more accuracy will be used combined in order to contrasting with each way singly. Results 70 abnormal parathyroid lesions were found in 70 patients with parathyroid glands. Pathological diagnosis proved that 42 cases of them were parathyroid adenoma and parathyroid hyperplasia in the other 28 cases. Among the different imaging modalities, the highest diag- nostic sensitivity belonged to the SPECT/CT. The ultrasound had highest specificity. The combination of the two methods had bet- ter performance. Conclusion SPECT/CT proved better in diagnosis than the planar seintigraphy in dual time. The combined of SPECT/CT and ultrasound examination can provide more information for the next treatment.