^(99)Tc^(m)-MIBI SPECT/CT显像联合超声检查在甲状旁腺功能亢进症合并甲状腺癌诊断中的应用

Combined application of ^(99)Tc^(m)-methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography and ultrasonography for the diagnosis of coexisting hyperparathyroidism and thyroid carcinoma

目的探讨^(99)Tc^(m)-甲氧基异丁基异腈(MIBI)单光子发射计算机断层成像/计算机断层扫描(SPECT/CT)显像联合超声对甲状旁腺功能亢进症(HPT)合并甲状腺癌(TC)的术前诊断价值。方法回顾性研究。纳入2013年9月—2019年12月经东南大学医学院附属江阴医院乳甲科手术及病理证实的HPT合并TC患者15例,其中男3例、女12例,年龄35~57岁(中位年龄49岁);继发性HPT 10例,原发性HPT 5例。统计术中检出并经术后病理证实的甲状旁腺病灶及TC病灶数;由多学科团队分析术前^(99)Tc^(m)-MIBI SPECT/CT显像及超声检查,比较^(99)Tc^(m)-MIBI SPECT/CT显像及超声对病变甲状旁腺及TC的检出率有无差异。结果15例HPT合并TC患者术中检出并经术后病理证实的甲状旁腺病灶44枚,^(99)Tc^(m)-MIBI SPECT/CT显像的检出率为86.4%(38/44),高于超声的检出率65.9%(29/44),差异有统计学意义(P<0.05)。10例继发性HPT合并TC患者手术检出39枚甲状旁腺病灶,^(99)Tc^(m)-MIBI SPECT/CT显像及超声则分别检出33枚(84.6%)和27枚(69.2%),两者比较差异无统计学意义(P>0.05);5例原发性HPT合并TC患者均为单发病灶,^(99)Tc^(m)-MIBI SPECT/CT显像检出5枚,超声检出2枚、漏检3枚。15例患者术中检出并经术后病理证实的TC病灶共16枚,其中单发14例、多发1例(2枚),^(99)Tc^(m)-MIBI SPECT/CT显像对TC病灶的检出率为5/16低于超声的12/16,两者比较差异有统计学意义(P<0.05)。结论^(99)Tc^(m)-MIBI SPECT/CT显像对HPT合并TC的甲状旁腺病灶的检出率优于超声,而超声对合并的TC诊断优于^(99)Tc^(m)-MIBI SPECT/CT显像,两者联合应用有助于HPT合并TC的诊断。

Objective This work aims to investigate the value of the combined application of ^(99)Tc^(m)-methoxyisobutylisonitrile(MIBI)single-photon emission computed tomography/computed tomography(SPECT/CT)and ultrasonography in the diagnosis of coexisting hyperparathyroidism(HPT)and thyroid carcinoma(TC).Methods A retrospective study was conducted in the Affiliated Jiangyin Hospital of Southeast University Medical College.Images of 15 cases of coexisting HPT and TC confirmed by histopathology from September 2013 to November 2019 were collected.The subjects included three males and 12 females,with a median age of 49(35-57)years.The number of parathyroid and TC lesions during operation was counted.^(99)Tc^(m)-MIBI SPECT/CT and ultrasonography features were analyzed by multiple disciplinary teams,and the accuracy localizations of ^(99)Tc^(m)-MIBI SPECT/CT and ultrasonography parathyroid and TC lesions were compared.Results Among the 15 patients with coexisting HPT and TC,a total of 44 parathyroid lesions were found;the detection rates of ^(99)Tc^(m)-MIBI SPECT/CT and ultrasonography were 86.4%(38/44)and 65.9%(29/44),respectively,with a statistically significant difference(P<0.05).Of 39 parathyroid lesions in 10 secondary HPT,the detection rates of ^(99)Tc^(m)-MIBI SPECT/CT and ultrasonography were 84.6%(33/39)and 69.2%(27/39),respectively;the difference was not statistically significant(P>0.05).Among five cases of primary HPT,^(99)Tc^(m)-MIBI SPECT/CT detected five parathyroid lesions,and ultrasonography detected two parathyroid lesions;three parathyroid lesions were misdiagnosed.In the coexisting TC with 16 lesions,14 cases had a single lesion,and one case was with two lesions;the detection rates of ^(99)Tc^(m)-MIBI SPECT/CT and ultrasonography were 5/16 and 12/16,respectively,with a statistically significant difference(P<0.05).Conclusions ^(99)Tc^(m)-MIBI SPECT/CT has higher detection rate for parathyroid lesions than ultrasonography,whereas ultrasonography has a higher detection rate for coexisting TC lesions than ^(99)Tc^(m)-MIBI SPECT/CT.The combined application of ^(99)Tc^(m)-MIBI SPECT/CT and ultrasonography contributes to the diagnosis of coexisting HPT and TC.