彩超与99mTc-MIBI SPECT/CT融合显像在继发性甲状旁腺功能亢进术前定位中的应用

Application of color Doppler ultrasound and 99mTc-MIBI SPECT/CT fusion imaging in preoperative localization of secondary hyperparathyroidism

目的探讨彩超与99mTc-MIBI SPECT/CT融合显像检查在继发性甲状旁腺功能亢进(SHPT)患者术前定位中的诊断价值。方法回顾性分析150例诊断为SHPT并接受手术治疗的慢性肾病(CKD)患者的临床资料。以术后病理结果作为金标准,对比甲状旁腺彩超、99mTc-甲氧基异丁基异腈(99mTc-MIBI)单光子发射计算机断层扫描/电子计算机断层扫描(SPECT/CT)融合显像对甲状旁腺的检出率、敏感性和检查效能,比较2种检查方法在SHPT术前定位中的诊断价值。结果术后病理共检出增生/瘤变的甲状旁腺571枚,彩超检出率为94.05%,敏感性为79.33%;99mTc-MIBI SPECT/CT融合显像检出率为96.32%,敏感性为87.33%;彩超联合99mTc-MIBI SPECT/CT融合显像共发现甲状旁腺558枚,检出率为97.72%,敏感性为89.33%。彩超检查与2种方法联合检查相比,两者的敏感性存在显著差异(P=0.017)。彩超和99mTc-MIBI SPECT/CT融合显像的检验效能存在显著差异(P=0.008)。结论99mTc-MIBI SPECT/CT融合显像应用于SHPT术前甲状旁腺定位的检验效能明显高于彩超,2种方法联合使用可以最大程度地发现增生的甲状旁腺,提高术前定位的精确性。

Objective To investigate the diagnostic value of color Doppler ultrasound and 99mTc-MIBI SPECT/CT fusion imaging in preoperative localization of patients with secondary hyperparathyroidism(SHPT).Methods The clinical data of 150 patients with chronic kidney disease(CKD)who were diagnosed with SHPT and received surgical treatment were retrospectively analyzed.The postoperative pathological results were used as the gold standard.The detection rate,sensitivity and detection efficiency for detecting parathyroid glands were compared between color Doppler ultrasound and 99mTc-methoxy isobutyl isonitrile(99mTc-MIBI)single photon emission computed tomography/computed tomography(SPECT/CT)fusion imaging,and the diagnostic value in preoperative localization of SHPT of the two methods was compared.Results A total of 571 hyperplasia/neoplastic parathyroid glands were detected by postoperative pathology.The detection rate of color Doppler ultrasound was 94.05% and the sensitivity was 79.33%.The detection rate of 99mTc-MIBI SPECT/CT fusion imaging was 96.32% and the sensitivity was 87.33%.A total of 558 parathyroid glands were found by color Doppler ultrasound combined with 99mTc-MIBI SPECT/CT fusion imaging,the detection rate was 97.72%,and the sensitivity was 89.33%.There was a significant difference in the sensitivity between color Doppler ultrasound and the combination of color Doppler ultrasound amd 99mTc-MIBI SPECT/CT fusion imaging(P=0.017).There was a significant difference in the detection efficiency between color Doppler ultrasound and 99mTc-MIBI SPECT/CT fusion imaging(P=0.008).Conclusion The detection efficiency of 99mTc-MIBI SPECT/CT fusion imaging in preoperative parathyroid localization is significantly higher than that of color Doppler ultrasound.The combination of both two methods can detect hyperplastic parathyroid glands to the greatest extent and improve the accuracy of preoperative localization.