^(99m)Tc-MIBI针孔准直器双时相显像与平行孔准直器SPECT/CT断层融合显像术前定位诊断原发性甲状旁腺功能亢进症的临床价值比较

Clinical Values of ^(99m)Tc⁃MIBI Pinhole Dual⁃phase and Parallel⁃hole SPECT/CT for Preoperative Localization in Patients with Primary Hyperparathyroidism

目的比较术前^(99m)Tc-甲氧基异丁基异腈(methoxyisobutylisonitrile,MIBI)针孔准直器双时相显像与平行孔准直器单光子发射计算机断层显像(single photon emission computed tomography,SPECT)/CT断层融合显像在原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)术前定位诊断中的临床价值。方法回顾性收集2021年7月—2022年2月北京协和医院疑诊PHPT患者的术前^(99m)Tc-MIBI甲状旁腺显像资料。以术后组织病理为金标准,计算^(99m)Tc-MIBI针孔准直器双时相显像与平行孔准直器SPECT/CT断层融合显像检出PHPT病灶的灵敏度、准确度、阳性预测值,并分析甲状旁腺激素(parathyroid hormone,PTH)对上述两种显像方法检出PHPT病灶的影响。结果共入选135例行^(99m)Tc-MIBI甲状旁腺显像的疑诊PHPT患者。^(99m)Tc-MIBI针孔准直器双时相显像共检出病灶149个(包括1个异位病灶)、平行孔准直器SPECT/CT断层融合显像共检出病灶148个(包括11个异位病灶;1个真阳性病灶为2个病灶融合而成,该方法无法分辨),二者检出PHPT病灶的灵敏度(79.9%比74.8%,P=0.326)、准确度(79.2%比75.7%,P=0.490)、阳性预测值(98.3%比100%,P=0.499)均无显著差异。在PTH≤150 ng/L、PTH>150 ng/L亚组中,^(99m)Tc-MIBI针孔准直器双时相显像检出PHPT病灶的灵敏度(79.1%比80.5%,P=0.838)、准确度(77.5%比80.8%,P=0.688)、阳性预测值(96.4%比100%,P=0.219)均无显著差异;SPECT/CT断层融合显像的灵敏度(71.6%比77.6%,P=0.445)、准确度(73.2%比77.9%,P=0.567)、阳性预测值(100%比100%,P>0.999)亦均无显著差异。结论^(99m)Tc-MIBI针孔准直器甲状旁腺双时相显像及平行孔准直器SPECT/CT断层融合显像对PHPT均具有较好的诊断能力且受PTH水平变化的影响不显著,由于^(99m)Tc-MIBI针孔准直器甲状旁腺双时相显像分辨率高,其仍是目前PHPT术前定位诊断的重要依据,而平行孔准直器SPECT/CT断层融合显像对于异位PHPT的诊断具有明显优势,在一些特殊情况下值得被推荐。

Objective To evaluate the clinical values of preoperative ^(99m)Tc⁃methoxyisobutylisonitrile(MIBI)pinhole collimator duplex imaging versus parallel⁃hole collimator single photon emission computed tomography(SPECT)/CT tomography fusion imaging in the preoperative localization of primary hyperparathy⁃roidism(PHPT).Methods In this diagnostic test,the patients with suspected PHPT in Peking Union Medi⁃cal College Hospital from July 2021 to February 2022 were retrospectively analyzed.With postoperative histo⁃pathology as the gold standard,the sensitivity,accuracy,and positive predictive value of ^(99m)Tc⁃MIBI pinhole collimator duplex imaging and parallel⁃hole collimator SPECT/CT tomographic fusion imaging for the detection of PHPT lesions were calculated,and the effect of parathyroid hormone(PTH)on the detection of PHPT le⁃sions by these two diagnostic methods was analyzed.Results A total of 135 patients with suspected PHPT on ^(99m)Tc⁃MIBI parathyroid imaging were enrolled.A total of 149 lesions were detected on ^(99m) Tc⁃MIBI pinhole collimator diachronic imaging(including 1 ectopic lesion)and 148 lesions were detected on parallel⁃hole col⁃limator SPECT/CT tomographic fusion imaging(including 11 ectopic lesions;1 true positive lesion was a fu⁃sion of 2 lesions that could not be distinguished by this method).The sensitivity(79.9%vs.74.8%,P=0.326),accuracy(79.2%vs.75.7%,P=0.490)and positive predictive value(98.3%vs.100%,P=0.499)of the two methods for detecting PHPT lesions were not significantly different.In the subgroups with PTH≤150 ng/L and PTH>150 ng/L,the sensitivity(79.1%vs.80.5%,P=0.838),accuracy(77.5%vs.80.8%,P=0.688),and positive predictive value(96.4%vs.100%,P=0.219)of ^(99m)Tc⁃MIBI pin⁃hole collimator diachronic imaging in detecting PHPT lesions were not significantly different;the sensitivity(71.6%vs.77.6%,P=0.445),accuracy(73.2%vs.77.9%,P=0.567),and positive predictive val⁃ue(100%vs.100%,P>0.999)of SPECT/CT fusion imaging were also not significantly different.Conclusions Both ^(99m) Tc⁃MIBI pinhole collimator parathyroid duplex imaging and parallel⁃hole collimator SPECT/CT tomographic fusion imaging have good diagnostic ability for PHPT and are not significantly affected by changes in PTH levels.Due to the high resolution of ^(99m)Tc⁃MIBI pinhole collimator parathyroid du⁃plex imaging,it is still an important basis for preoperative localization and diagnosis of PHPT,while parallel⁃hole collimator SPECT/CT tomographic fusion imaging has obvious advantages for the diagnosis of ectopic PHPT and is recommended in some special cases.