常规超声与^(99m)Tc-MIBI显像在甲状旁腺增生与甲状旁腺腺瘤鉴别诊断中的价值

Ultrasound and^(99m)Tc-MIBI Scintigraphy in Differentiating between Parathyroid Hyperplasia and Parathyroid Adenoma

背景甲状旁腺病变的不同病理类型决定其治疗方案的选择及预后,超声及^(99m)Tc-MIBI显像技术在诊断甲状旁腺病变中已广泛应用。目前已有研究表明,不同病理分型的甲状旁腺病变有不同的超声及核素表现,而如何从诸多超声特征及核素图像中提取各型病变的特征性指标是目前研究的难点。目的比较甲状旁腺增生(PH)与甲状旁腺腺瘤(PA)的常规超声及^(99m)Tc-MIBI显像特点,探讨常规超声与^(99m)Tc-MIBI显像鉴别诊断PH与PA的价值。方法选取2016年2月—2022年3月石河子大学医学院第一附属医院收治的150例(共199个结节)行甲状旁腺切除的患者资料,术前患者均行甲状旁腺常规超声检查及^(99m)Tc-MIBI显像,以术后病理检查结果为“金标准”,比较PH和PA的常规超声及^(99m)Tc-MIBI显像差异,采用受试者工作特征曲线(ROC曲线)分析常规超声与^(99m)Tc-MIBI显像对PH、PA的鉴别诊断价值。结果常规超声鉴别诊断PH、PA的灵敏度、特异度、准确率、ROC曲线下面积(82.14%、89.51%、87.43%、0.885)均高于^(99m)Tc-MIBI显像(50.00%、64.34%、60.30%、0.775)(P<0.05)。结论常规超声与^(99m)Tc-MIBI显像对PA、PH均有一定诊断价值,且常规超声对PA、PH的鉴别诊断效能优于^(99m)Tc-MIBI显像。

Background Different pathological types of parathyroid lesions determine the choice of treatment and prognosis.Ultrasound and^(99m)Tc-MIBI scintigraphy techniques have been widely used in the diagnosis of parathyroid lesions.Studies have shown that ultrasound and radionuclide manifestations of parathyroid lesions differ by the pathological type,but how to extract the characteristic indices of various types of parathyroid lesions from many ultrasound features and^(99m)Tc-MIBI scintigraphy is a difficulty of current research.Objective To compare the value of ultrasound versus^(99m)Tc-MIBI scintigraphy in differentiating between parathyroid hyperplasia(PH)and parathyroid adenoma(PA)by analyzing the features of PH and PA measured by them.Methods One hundred and fifty patients with 199 thyroid lesions in total who underwent parathyroidectomy in First Affiliated Hospital,School of Medicine,Shihezi University from February 2016 to March 2022 were selected.Parathyroid ultrasound and^(99m)Tc-MIBI scintigraphy were performed before operation,and the detected results by them were comparatively assessed with postoperative pathological findings as the gold standard for reference.The receiver operating characteristic(ROC)analysis was used to estimate the value of the two modalities in differentiating between PH and PA.Results Compared with^(99m)Tc-MIBI scintigraphy,ultrasound had higher sensitivity(82.14%vs 50.00%),specificity(89.51%vs 64.34%),accuracy(87.43%vs 60.30%)and larger area under the ROC curve(0.885 vs 0.775)(P<0.05)in differentiating between PH and PA.Conclusion Both ultrasound and^(99m)Tc-MIBI scintigraphy could differentiate between PA and PH,but the performance of ultrasound was better.