^(99m)Tc-MIBI SPECT/CT显像在原发性甲状旁腺功能亢进症术前诊断中的应用价值

Value of 99m Tc-MIBI SPECT/CT in pre-operative diagnosis of primaryhyperparathyroidism

目的通过与^(99m)锝-甲氧基异丁基异腈(^(99m)Tc-sestamibi,^(99m)Tc-MIBI)双时相平面显像和超声检查比较,评价^(99m)Tc-MIBI单光子发射计算机断层显像(single photon emission computed tomography,SPECT)/电子计算机断层显像(computed tomography,CT)在原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)患者术前诊断中的应用价值。方法回顾性分析在首都医科大学宣武医院病理确诊PHPT的101例患者(男性23例,女性78例,年龄14~74岁)的^(99m)Tc-MIBI SPECT/CT显像结果,并与双时相平面显像和超声检查结果进行比较,以手术病理结果为“金标准”,分别计算3种检查方法诊断PHPT的灵敏度、特异度、准确率、阳性预测值和阴性预测值,并应用SPSS 23.0软件进行χ^(2)检验,对不同检查方法的诊断效能进行比较。同时,对SPECT/CT与双时相平面显像的阳性和阴性病灶大小行t检验进行比较分析。结果101例患者经术后病理证实共有120枚甲状旁腺病灶、93例为单发病灶,8例为多发病灶。120枚甲状旁腺病灶含89枚腺瘤(其中8枚为异位腺瘤)、5枚非典型腺瘤、24枚增生病灶(含异位3枚)、2枚甲状旁腺癌。^(99m)Tc-MIBI SPECT/CT显像对PHPT病灶诊断的灵敏度、特异度、准确率、阳性预测值和阴性预测值分别为90.00%、99.64%、96.78%、99.08%和95.93%,平面显像对应的结果分别为76.67%、99.30%、92.57%、97.87%和90.97%,超声检查对应的结果分别为82.50%、99.64%、94.55%、99.00%和93.09%,其中^(99m)Tc-MIBI SPECT/CT显像的灵敏度(χ^(2)=14.062,P<0.001)、准确率(χ^(2)=15.059,P<0.001)和阴性预测值(χ^(2)=6.034,P<0.05)均高于平面显像,而与超声检查的灵敏度和准确率差异无统计学意义(P>0.05)。SPECT/CT和平面显像阳性病灶的最大径分别为(1.90±0.98)cm和(2.01±0.99)cm,明显大于其显像阴性病灶(1.36±0.54)cm和(1.25±0.67)cm(t值分别为2.311和3.827,均P<0.05)。结论^(99m)Tc-MIBI SPECT/CT显像诊断PHPT具有较高的灵敏度、准确率和阴性预测值,对PHPT术前定位定性诊断有重要临床应用价值。

Objective To evaluate the clinical value of ^(99m) Tc-sestamibi(^(99m) Tc-MIBI)single photon emission computed tomography(SPECT)/computed tomography(CT)in preoperative diagnosis of primary hyperparathyroidism(PHPT)by comparing with ^(99m) Tc-MIBI dual-phase planar imaging and ultrasonography.Methods A total of 101 patients(23 males,78 females,14-74 years old)who had received parathyroidectomy from Xuanwu Hospital,Capital Medical University were enrolled into this retrospective study.The pathological results were considered as the gold standard.The diagnostic efficiencies(sensitivity,specificity,accuracy,positive predictive value,and negative predictive value)of ^(99m) Tc-MIBI SPECT/CT were compared with ^(99m) Tc-MIBI dual-phase planar imaging and ultrasound examination usingχ2 test.The size of positive lesions was compared with negative lesions in ^(99m) Tc-MIBI SPECT/CT and ^(99m) Tc-MIBI dual-phase planar imaging using t test respectively.Results A total of 120 PHPT lesions were found in 101 patients,of which 93 cases had single lesion and 8 cases had multiple lesions,and 120 lesions included 89 parathyroid adenomas(8 ectopic adenomas),5 atypical adenomas,24 hyperplastic lesions(3 ectopic lesions),and 2 parathyroid carcinomas.The diagnostic sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of ^(99m) Tc-MIBI SPECT/CT for PHPT were 90.00%,99.64%,96.78%,99.08%,and 95.93%respectively.The corresponding results of dual-phase planar imaging were 76.67%,99.30%,92.57%,97.87%,and 90.97%respectively.The corresponding results of ultrasound examination were 82.50%,99.64%,94.55%,99.00%,and 93.09%respectively.The sensitivity(χ^(2)=14.062,P<0.001),accuracy(χ^(2)=15.059,P<0.001),and negative predictive value(χ^(2)=6.034,P<0.05)of ^(99m) Tc-MIBI SPECT/CT for PHPT were higher than those of planar imaging.In contrast there were no significant differences in sensitivity and accuracy between ^(99m) Tc-MIBI SPECT/CT and ultrasound examination(P>0.05).The maximum diameters of positive lesions of SPECT/CT and planar imaging were(1.90±0.98)cm and(2.01±0.99)cm,respectively,which were significantly larger than those of negative lesions(1.36±0.54)cm and(1.25±0.67)cm(t =2.311,3.827,both P<0.05),respectively.Conclusion There were higher sensitivity,accuracy,and negative predictive value of ^(99m) Tc-MIBI SPECT/CT in the diagnosis of PHPT,which has important clinical application value in preoperative localization and qualitative diagnosis of PHPT.