原发性甲旁亢中异位甲状旁腺腺瘤的MDCT表现

MDCT Findings of Ectopic Parathyroid Adenoma in Primary Hyperparathyroidism

目的:总结原发性甲状旁腺功能亢进症(PHPT)中异位甲状旁腺腺瘤(EPA)的MDCT表现,增加对该疾病的认识。方法:收集我院2012年1月至2019年3月的PHPT患者中,经病理确诊为EPA的共19例,其中男性6例,女性13例,年龄33~76(56+14)岁:采用64排MDCT完成颈胸部增强扫描,层厚2.5mm。结果:19例均为单发病灶,位于颈部8例,纵隔11例,多位于气管食管沟或前上纵隔。病灶最大径0.8~4.1cm,平扫CT值20~63HU,增强后呈明显强化,CT值94~233HU,其中12例强化均匀,7例强化不均匀,6例病灶最大径>2cm,其中5例(83.3%)强化不均匀。结论:EPA常发生于气管食管沟或前上纵隔,增强CT上多表现为均匀强化的富血供结节,病灶较大时常呈不均匀强化。对于疑诊EPA的PHPT患者,建议做颈部及胸部的薄层CT增强检查,帮助提高术前定位诊断的准确率。

Purpose:To summarize the common locations and MDCT manifestations of ectopic parathyroid adenomas(EPA)in primary hyperparathyroidism(PHPT),and to increase the understanding of the disease.Methods:MDCT data of 19 pathologically proved EPA patients in our hospital from January 2012 to March 2019 were analyzed.The locations and MDCT findings of these lesions were summarized.Result:All these patients underwent neck and chest enhanced CT,19 lesions were found including 8 cervical lesions and 11 mediastinal lesions,the most common sites were tracheoesophageal sulcus and anterior superior mediastinum.The max imum diameters of these lesions were 0.8-4.1 cm(1.8+1.0)and the CT values were 20-63(38+12)HU on non-enhanced CT scan.After injection of contrast,all these lesions showed obvious enhancement,the CT value were 94-233(138+38)HU.Twelve of 19 lesions showed homogenous enhancement after injection,7(36.8%)of them showed heterogeneous enhancement,and we also found that among the 6 lesions larger than 2 cm,5(83.3%)lesions showed heterogeneous enhancement.Conclusion:The most common sites of EPA are tracheoesophageal sulcus and anterior superior mediatinum.On contrastenhanced CT,most of them show homogencous enhancement,while larger lesions tend to show heterogeneous enhancement.For PHPT patients suspected of EPA,enhanced CT of neck and chest should be recommended to help preoperative localization.